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CMS answers PTAN, revalidation questions

DecisionHealth stock imageWe report in the current issue of Part B News that you could get a revalidation notice from CMS this year, even for providers who already have records in the agency’s Provider Enrollment Chain Ownership System (PECOS).

Remember: CMS had previously said no providers with existing PECOS records would get revalidation notices until January 2012, when a big “wave” of notices would be sent out.

The culprits are active provider transaction account numbers (PTANs), which cause the revalidations to be sent when they are on file with a Medicare contractor but not listed in a provider’s PECOS record, CMS has said.

Now the agency has answered some questions about the PTAN and revalidation issue. These questions were asked by consultant David Zetter, of Zetter Practice Management Consultants in Mechanicsburg, Pa., with responses coming from officials with CMS’s Center for Program Integrity division.

Q: If a provider has multiple PTANs still on record with Medicare, but a PTAN is not reflected in a PECOS enrollment record, they could receive a revalidation letter sooner than later?  Even though they aren’t aware of existence of the PTAN.

A: That’s correct.

Q: How does one get rid of a PTAN besides withdrawing a Medicare enrollment or reassignment?  What if the PTAN is linked to a location in a large practice?  Just delete the location and the PTAN goes away?

A: If they no longer need the PTAN they can contact the MAC and ask for the PTAN to be end dated (voluntarily terminate) that PTAN.

Q: Why is Medicare still using PTANs since we now have NPIs?

A: Yes, it is confusing. The NPI is what we use to identify the individual/organization. The PTANs are generated by the contractor and defines where the payment is sent. So for example one NPI can have multiple PTANs if that doctor is reassigning benefits to multiple organization. We are actively working on guidance around this to make it clearer to the provider community.

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