CMS Manual System

CMS Manual System

Pub 100-08 Medicare Program Integrity

Transmittal 244

Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS)

Date: FEBRUARY 29, 2008

Change Request 5906

SUBJECT: Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-toOne National Provider Identifier (NPI) Match

I. SUMMARY OF CHANGES: The CMS believes providers and suppliers have been or will be contacting contractors to collapse the assigned Medicare PTANs to insure a one-to-one NPI match. These entities would prefer to collapse the group and individual PTANs assigned to the additional locations in to one PTAN to be used for all locations. This can only be accomplished if the additional locations are all assigned the same tax identification number and are within the same pricing locality.

NEW/REVISED MATERIAL EFFECTIVE DATE: JANUARY 1, 2008 IMPLEMENTATION DATE: APRIL 7, 2008

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED

R/N/D N/A

CHAPTER / SECTION / SUBSECTION / TITLE

III. FUNDING:

SECTION A: For Fiscal Intermediaries and Carriers: No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.

SECTION B: For Medicare Administrative Contractors (MACs): The Medicare administrative contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the contracting officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

IV. ATTACHMENTS:

One-Time Notification

*Unless otherwise specified, the effective date is the date of service.

Attachment ? One-Time Notification

Pub. 100-08 Transmittal: 244 Date: February 29, 2008 Change Request: 5906

SUBJECT: Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-toOne National Provider Identifier (NPI) Match

Effective Date: January 1, 2008 Implementation Date: April 7, 2008

I. GENERAL INFORMATION

A. Background: To ensure that carriers are assigning PTANs in a more consistent manner and to aid in the implementation of the National Provider Identifier crosswalk, carriers shall only assign the minimum number of PTANs necessary to ensure that proper payments are made. Carriers shall not assign an additional PTAN(s) to a physician, non-physician practitioner, or other supplier merely because the individual or entity requests one, the only exception being for hospitals that request separate billing numbers for their hospital departments in Section 2C of the CMS-855B enrollment application.

At present, Medicare carriers issue PTANs to physicians, non-physician practitioners, and other suppliers with multiple practice locations in an inconsistent fashion. Some carriers issue a single PIN that encompasses all of the individual's or entity's practice locations. Other carriers assign one PIN for each of the individual's or entity's locations. If the entity is a group practice, the carrier might also assign each physician a separate PIN for each of the group's locations.

B. Policy: Changes in the Medicare provider and supplier enrollment process over the years have resulted in differences in the Medicare PTAN assignment process. Those differences, combined with Medicare's requirement to capture the NPI as part of the enrollment process, affect the type of information that is collected in the enrollment process, maintained in PECOS, and transferred to MCS and Medicare's NPI crosswalk. CMS believes providers and suppliers have been or will be contacting contractors to collapse the assigned Medicare PTANs to insure a one-to-one NPI match. These entities would prefer to collapse the group and individual PTANs assigned to the additional locations in to one PTAN to be used for all locations. This can only be accomplished if the additional locations are all assigned the same tax identification number (TIN) and are within the same pricing locality.

The PECOS via the web to be implemented in FY 08 will not support collapsing of assigned Medicare PTANs by a provider or supplier. Therefore, if a provider or supplier requests to collapse their Medicare PTANs, this process will have to be done by the CMS 855 paper application process.

II. BUSINESS REQUIREMENTS TABLE Use"Shall" to denote a mandatory requirement

Number Requirement

Responsibility (place an "X" in each applicable column)

A D F C R Shared/ M I A H System B E R H Maintainer

RI s

OTH ER

CMS / CMM / MCMG / DCOM Change Request Form: Last updated 08 November 2007 Page 1

5906.1 Contractors shall not volunteer to collapse PTANs. X

5906.2 Contractors shall inform providers and suppliers to X

request the collapsing of their group and/or

individual PTANs on their letterhead.

5906.2.1 Contractors shall request the letter contain:

X

the TIN of the entity and/or

the Social Security Number (SSN) of the

individual(s)

the effective date for the collapsed PTANs.

The authorized official must sign the request.

This letter may be faxed to the contractors.

5906.2.2 Contractors shall request provider (group) to

X

completed the following sections on the CMS 855B

application:

Section 1.A ? You are changing your information Section 1.B ? Practice Location Information Section 2.B.3 Correspondence Address Section 3 ? Adverse Legal Actions/Convictions Section 4 may be replaced with spreadsheet from BR 2.4. Section 13- Contact Person Section 15 ? Certification Statement

5906.2.3 5906.2.4

If the provider is not in PECOS, the contractor shall X request a complete CMS 855B application. Contractors may also request the provider to provide X a spreadsheet with the following: all the PTAN(s) for both the group(s) and individual(s) with the associated NPIs Practice location address(es) for the group Special Payment address

5906.2.5 5906.3 5906.3.1 5906.3.2

Contractors may request the provider to indicate on X the spreadsheet the group or individual PTANs that are to remain active and which are to be end dated. Contractors shall determine if the collapse request X contains all required information. If not, develop the application for additional information. If the PTAN the provider indicates as active is not in X PECOS, the contractor shall request a complete CMS 855B be submitted. Contractors shall determine the end date provided by X the provider is not before the last claims filed on any of the group PTANs.

CMS / CMM / MCMG / DCOM Change Request Form: Last updated 08 November 2007 Page 2

F MV C I C MW SSSF S X X X

X

X X

X X X X

Number

5906.3.3 5906.3.4 5906.3.5

5906.4 5906.4.1 5906.5 5906.5.1 5906.6 5906.6.1

5906.7 5906.8

Requirement

Contractors shall identify the entire group PTANs. (PSUP Query). Contractors shall determine the oldest participation date (PAR date) to be used. Contractors shall verify the specialties and the special payment address information is consistent with the entire group PTANs. If not, that specific information must be submitted as a CMS 855B change of information and processed through PECOS before collapsing of group PTANs can continue. (Single and multiple specialty groups can be considered the same). If the groups PTANs are in PECOS, contractors shall end date the collapsed group PTANs in Section 1. Contractors shall correct the group PTANs and NPIs in Section 4 to the active PTAN and NPI for all practice locations and special payment addresses. If the group PTAN is not in PECOS, contractors shall end date the V2 screen in MCS with AR 72. If the group PTAN is not in PECOS the contractors shall document the MCS comment screen and note the active PTAN. Contractors shall determine if the individual reassigning benefits has an active PTAN under the `new' group PTAN in PECOS. If the individual has an active number to the `new' group PTAN, the contractor shall end date all other active numbers for that individual under that group in PECOS, Section 1, and if applicable in PECOS Section 4. If the individual PTANs are not in PECOS, contractors shall end date the V2 screen in MCS with AR 72. If the individual does not have an active individual PTAN under the `new' group PTAN, contractors shall issue a new PTAN. (You can not change an existing individual PTAN to a different group PTAN without causing adjustments to create overpayments).

Responsibility (place an "X" in each applicable column)

A D F C R Shared- OTH

/ M I A H System

ER

B E R H Maintainer

RI s

MM I

F MV C

A A E I C MW

CC R S S S F

S

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

CMS / CMM / MCMG / DCOM Change Request Form: Last updated 08 November 2007 Page 3

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