Full Answer
Where can I find the railroad Medicare ptan form?
This tool replaces the "Request for Railroad Medicare PTAN for Electronic Submitters" form. You can access the tool at www.PalmettoGBA.com/RR/PTAN .
How do I obtain my railroad Medicare provider transaction access number?
Providers can now obtain their existing Railroad Medicare Provider Transaction Access Number (PTAN) or request a new Railroad Medicare PTAN through our PTAN Lookup and Request Tool. This tool replaces the "Request for Railroad Medicare PTAN for Electronic Submitters" form.
Can the ptan lookup and request tool assign a new railroad ptan?
The PTAN Lookup and Request Tool is not able to assign a new Railroad Medicare PTAN in the following circumstances: The provider is enrolled under a Social Security Number (SSN) instead of under a Tax Identification Number (TIN)
How do I obtain a ptan for providers that are waived?
Providers that are waived from filing electronically may submit their initial paper claims to obtain a PTAN.
How do I bill railroad Medicare claims?
Getting Started With Railroad Medicare BillingStep 1: Ensure your enrollment information is correct with your local Part B Medicare Administrative Contractor (MAC) ... Step 2: Request a Railroad Medicare PTAN. ... Step 3: Receive your Railroad Medicare PTAN. ... Step 4: File Electronically. ... Step 5: Go Green — Electronic Remits.
Is railroad Medicare the same as Medicare?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment.
What is railroad Ptan?
This tool allows you to access your existing Provider Transaction Access Number (PTAN) or to request a new PTAN. If you are new to Railroad Medicare, you can request a PTAN if you are already enrolled with your local Medicare Administrative Contractor (MAC) and have a claim to submit for a Railroad Medicare patient.
What is the EDI number for railroad Medicare?
The packet contains forms and explanations for each of the services offered by our Electronic Data Interchange (EDI) department. For further information regarding any of this material, please call the Railroad Medicare Provider Contact Center at 888-355-9165.
Where do I file a railroad Medicare claim?
You can either file electronic claims to Railroad Medicare through a clearinghouse or other third-party claims submitter, or you can submit paperless claims directly through Palmetto GBA's online provider portal eServices eClaims option.
Is railroad Medicare a Medicare Advantage Plan?
Yes, Railroad Medicare beneficiaries can choose to enroll in Medicare Advantage plans.
Is Ptan same as Medicare identification number?
The Provider Transaction Access Number (PTAN) is your unique Medicare identification number. This number is assigned to providers once their enrollment has been approved.
What is Palmetto GBA Railroad Medicare?
Palmetto GBA is the Railroad Specialty Medicare Administrative Contractor (RRB SMAC) and processes Part B claims for Railroad Retirement beneficiaries nationwide.
What does a Medicare Ptan number look like?
The Provider Transaction Access Number (PTAN) is a Medicare-issued number given to providers upon enrollment with Medicare. This number is usually six digits and is assigned based on the type of service and the location of the provider.
What is an EDI submitter?
A Submitter ID number is a unique number identifying electronic submitters. A Submitter ID can be used to transmit Part A, Part B and HHH EDI transactions to CGS. You must request a Submitter ID if you will be submitting claims directly to CGS.
How do I check my Railroad Medicare claims?
If you'd like to use the IVR, you can do so by calling 800–833–4455. From the main menu, press one (1) for claim status. You will need your Railroad Medicare number, date of birth, name, and date of service for the claim you are searching for. Claim status is available Monday thru Friday from 7 a.m. through 11 p.m. ET.
Will Railroad Medicare accept paper claims?
Only providers that meet the exceptions listed in CR 3440 can be granted a waiver to submit paper claims. You must have a Railroad Medicare PTAN before you can submit claims electronically to Railroad Medicare.
How to become a railroad Medicare provider?
The first step in becoming a Railroad Medicare provider is to request and receive a Railroad Medicare Provider Transaction Access Number (PTAN). You will need a separate PTAN for Railroad Medicare because we are a different jurisdiction from your local Part B Medicare Administrative Contractor (MAC). Before requesting a Railroad Medicare PTAN, you ...
Do you need to be enrolled in Medicare before requesting a PTAN?
Before requesting a Railroad Medicare PTAN, you must be actively enrolled with your local Part B MAC. Once you are enrolled as a Medicare Part B provider, you are eligible to render services for a Railroad Medicare beneficiary, but you must request and be assigned a Railroad Medicare PTAN before we can process your claims.
Does Railroad Medicare require CMS-855?
There are no CMS-855 enrollment forms required for Railroad Medicare. When you request a Railroad Medicare PTAN, Palmetto GBA verifies the enrollment information on file with your Part B MAC and creates a corresponding Railroad Medicare enrollment file. The effective date of your Railroad Medicare PTAN will be retroactive to the effective date ...
Can I request a PTAN for a railroad?
You can request a new Railroad Medicare PTAN for individual providers only (physician, non-physician practitioner, ambulance, laboratory, ambulatory surgical center, etc.). Please do not attempt to request a new PTAN for a group/practice. A group PTAN will be created when an individual PTAN is assigned to the first group member.
Is Railroad PTAN retroactive?
The effective date of your Railroad Medicare PTAN will be retroactive to the effective date of your Part B Medicare PTAN. If you have recently provided a Part B service to a Railroad Medicare beneficiary and are ready to submit your claim, follow these easy steps to request a Railroad Medicare Provider Transaction Access Number (PTAN).
What is a PTAN report?
PTANs in one report. (NPI), telephone and fax numbers. The NPI and the PTAN are related to each other for Medicare purposes. A provider must have one NPI and will have one, or more, PTAN (s) related to it in the Medicare system, representing the provider’s enrollment.
What is a PTAN number?
Provider Transaction Access Number (PTAN) A PTAN is a Medicare-only number issued to providers by MACs upon enrollment to Medicare. When a MAC approves enrollment and issues an approval letter, the letter will contain the PTAN assigned to the provider.
How are NPI and PTAN related?
The NPI and the PTAN are related to each other for Medicare purposes. A provider must have one NPI and will have one, or more, PTAN (s) related to it in the Medicare system, representing the provider’s enrollment.
When did Medicare require NPI?
Since May 23, 2008, Medicare has required that the NPI be used in place of all legacy provider identifiers, including the Unique Physician Identification Number (UPIN), as the unique identifier for all providers, and suppliers in HIPAA standard transactions.
When was 32B not reported?
Enter the ID qualifier 1C followed by one blank space and then the PIN of the service facility. Effective May 23, 2007, and later, 32b is not to be reported.
What is a PIN number?
An incorporated Solo Provider with one Legacy Provider Identification Number (PIN) and both an Individual National Provider identifier (NPI) number and a Group NPI number, must bill as follows:
What is the 837P form?
This booklet offers education for health care administrators, medical coders, billing and claims processing personnel, and other medical administrative staff who are responsible for submitting Medicare professional and supplier claims for Medicare payment using the 837P or Form CMS-1500.
What is the 837P?
The 837P is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard claim form to bill MACs when a paper claim is allowed.
What is Medicare claim processing manual?
The Medicare Claims Processing Manual (Internet-Only Manual [IOM] Pub. 100-04) includes instructions on claim submission. Chapter 1 includes general billing requirements for various health care professionals and suppliers. Other chapters offer claims submission information specific to a health care professional or supplier type. Once in IOM Pub. 100-04, look for a chapter(s) applicable to your health care professional or supplier type and then search within the chapter for claims submission guidelines. For example, Chapter 20 is the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).
What is MSP in Medicare?
MSP provisions apply to situations when Medicare isn’t the patient’s primary health insurance coverage.MSP provisions ensure Medicare doesn’t pay for services and items that pertain to other health insurance or coverage that’s primarily responsible for paying. For more information, refer to the Medicare Secondary Payer
What are the items that Medicare may be secondary to?
If there is insurance primary to Medicare, enter the insured’s policy or group number and then proceed to Items 11a–11c. Items 4, 6, and 7 must also be completed. Circumstances under which Medicare may be secondary to another insurer, includes: Group health plan coverage. Working aged;
When submitting paper or electronic claims, what is item 11?
When submitting paper or electronic claims, item 11 must be completed. By completing this information, the physician / supplier acknowledges having made a good faith effort to determine whether Medicare is the primary or secondary payer. Claims without this information will be rejected.
What is EOB in Medicare?
If the primary payer’s explanation of benefits (EOB) does not contain the claims processing address, record the claims processing address directly on the EOB. Completion of this item is conditional for insurance information primary to Medicare.
What to do if there is no Medicare primary?
If there is no insurance primary to Medicare, enter the word “none”. If there has been a change in the insured’s insurance status, e.g., retired, enter the word “none” and proceed to item 11b. Item 11a-Insured's date of birth: Enter the insured’s eight-digit birth date (MM/DD/CCYY) and sex if different from Item 3.
Does Medicare cover claims submitted on paper?
Reminder: Medicare will not cover claims submitted on paper that do not meet the limited exception criteria. Claims denied for this reason will contain a claim adjustment reason code and remark code indicating that the claim will not be considered unless submitted via an electronic claim.
Is Medicare required to pay item 29?
Not required by Medicare. Item 29-Amount paid: Enter only the amount the patient paid on Medicare covered services. Note: Providers should never enter the amount the primary insurance paid in Item 29 or the electronic equivalent.