Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

NPI and PTAN: What’s the Difference?

While federal law (HIPAA) mandates that all providers have a single unique NPI number to be used in all administrative and financial transactions by providers and health plans, Medicare providers also need a PTAN. Why both?

While Medicare requires only the NPI number for claims submission, the PTAN number is assigned by Medicare to authenticate the provider when using the local Medicare Administrative Contractor’s (MAC) self-help tools like the IVR, internet portal, on-line application status, etc.

A provider will only ever have one NPI but generally will be assigned a different PTAN for every practice, group, or MAC she is connected with. Medicare uses the NPI and PTAN together to identify the provider in their programs and maintains a record of both numbers in their Provider Enrollment Chain & Ownership System (PECOS).

Providers who are being asked to revalidate their enrollment information by Medicare need both their National Provider Identifier number (NPI) and Provider Transaction Access Number (PTAN) in order to complete the process.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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