Corporate Compliance

Note from Peggy: NPI vs. PTAN

Medicare Update for Physician Services, June 7, 2012

Were you ever curious about the difference between the National Provider Identifier (NPI) versus the Provider Transaction Access Number (PTAN)? Of course the NPI is a national number that allows all payers and all practitioners and other providers who are considered covered entities to communicate in the same language, at least as far as what provider we’re talking about. It has a single translation that equates to an individual or a hospital or some other type of healthcare entity such as a physician group practice. The NPI is assigned by the National Plan and Provider Enumeration System (NPPES). Physicians thought that they were going to be able to get rid of that long list of provider numbers that were uniquely theirs and different for every payer. But for Medicare, every entity receiving an NPI will also have a PTAN. Unlike the NPI which can be translated by virtually everybody, the PTAN only makes sense to the Medicare Administrative Contractor (MAC) that assigns it.

Continue reading Peggy's note at the Medicare Mentor blog

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