How Do I Lookup My Medicare Provider Number

How To Register For Proda

Before you start, you will need the information from 3 types of identification document. You don’t send in the documents themselves, you just need some information from them. Examples of valid documents are:

• Australian passport
• Certificate of registration by descent

Notes about identification:

• Create your account using your current legal name, as shown on your identity documents. The names you input will be used to verify your identity documents at a later step and inconsistencies will result in verification failure.
• If your current name is different to the name on any of your documents you will need to provide either an official marriage certificate or a change of name certificate .

Once you’ve established your identity and completed the account setup, you will be sent an RA number via email. Keep this number handy. It is a useful and important identifier, particularly for non-clinical staff who do not have an HPI-I or similar identifier .

Go to the PRODA webpage to register.

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This website and its contents are for informational purposes only and should not be a substitute for experienced medical advice. We recommend consulting with your medical provider regarding diagnosis or treatment, including choices about changes to medication, treatments, diets, daily routines, or exercise.

This communications purpose is insurance solicitation. A licensed insurance agent/producer or insurance company will contact you. Medicare Supplement insurance plans are not linked with or sanctioned by the U.S. government or the federal Medicare program.

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What Is My Medicare Number

Your Medicare Number is the 11 digit code on the front of your red, white, and blue Medicare card that Medicare uses to identify you. To help keep your personal information safe, your Medicare Number is no longer the same as your Social Security Number. Your Medicare Number is a unique combination of 11 letters and numbers.

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Not Sure What Type Of Provider You Need

Use our provider search tool to find quality data, services offered, and other information for these type of providers:

Nursing homes

Get detailed information about every Medicare-certified nursing home in the country. A nursing home is a place for people who cant be cared for at home and need 24-hour nursing care. Find nursing homes by location and compare the quality of care they give.

Hospitals

Find and compare hospitals that offer services like medical, surgical, and psychiatric care. Use the Hospital type” filter to find special facilities, like acute care, critical access, childrens hospitals, and more.

Doctors & clinicians

Find a doctor or clinician that accepts Medicare near you, or compare doctors who are qualified to practice in many specialties.

Home health services

Home health care describes a wide range of health care services that you can be get in your home at less expense than a hospital or skilled nursing facility. Compare home health agencies using the patient survey star ratings or the quality of patient care star rating.

Hospice care

Hospice agencies most often give services where you live, whether you’re at home, an assisted living facility, or a nursing home. Find hospices that serve your area and compare them based on the quality of care they give.

Inpatient rehabilitation facilities

Long-term care hospitals

Dialysis facilities

Medical supplies & equipment

What Do The Codes Following My Social Security Number Mean

Some people still keep and use the original copy of their red, white, and blue Medicare card containing their Social Security number.

After the Social Security number, there is a letter and sometimes a number. These codes all have different meanings.

The most common letters to find on your card following your Social Security number are A and B.

If you have an A on your card, it means that you are the primary beneficiary. That means you earned Medicare insurance based on your working history and tax credits.

If you have a B following your Social Security number, you are registered with Medicare as the spouse of a retired worker who earned Medicare.

There are several variations to the B code:

• B1 is for a husband of a primary beneficiary at age 62 or over.
• B2 is for a young wife with a child in her care,
• B3 is for an aged wife over the age of 62 who is a second claimant
• B5 is also a second claimant wife, but they are under the age of 62 and have a child in their care.
• B6 represents a divorced wife over the age of 62
• is for a young husband with a child in his care.

Additionally, Codes C1-C9 represent children who may be minors, students, or disabled.

The letter D follows for aged widows over the age of 60 or a surviving divorced wife over the age of 60.

The letter E code is for a widowed mother, while E1 is a surviving divorced mother.

E4 is a widowed father, and E5 is a surviving divorced father.

The letter F codes are for parents.

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About Medicare Provider Numbers

A Medicare provider number is a unique number you can get if youre an eligible health professional recognised for Medicare services. You need a provider number to claim, bill, refer or request Medicare services.

You must be registered with the Australian Health Regulation Agency or an approved registration body to apply for one.

Well always record your name on your provider number exactly as its registered with the relevant registration board or professional body.

Make sure you apply for one early. We get a high number of applications from December to April. During this time it can take a few weeks to get your provider number.

You cant access Medicare services until you have a provider number. You also cant use another health professionals provider number.

Youll need more than 1 Medicare provider number if you:

• deliver health services in different locations
• are registered in more than one health profession.

Find out how to apply for additional provider numbers.

Find & Compare Health Care Providers

Select the button below to find and compare nursing homes, hospitals, doctors, and other health care providers in your area that accept Medicare. Get information like:

• Quality ratings for local nursing homes and home health agencies
• Estimate of doctors’ costs in your area
• Dialysis facilities and hospitals near you
• Contact information for local inpatient rehabilitation centers

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Does Private Medicare Have Group Numbers

Original Medicare is not group coverage and therefore has no corresponding group number. But private Medicare plans may have a group number associated with the plan.

Private Medicare insurance includes:

• Medicare Part C . These plans provide all the same benefits as Medicare Part A and Part B while also typically offering some additional coverage for things not found in Original Medicare like dental, vision, prescription drugs and more.
• Medicare Part D . Medicare Part D provides coverage for prescription medications, which is a benefit not covered by Original Medicare.
• Medicare Supplement Insurance . Medicare Supplement Insurance works alongside your Original Medicare coverage by picking up the cost of certain deductibles, copayments, coinsurance and other out-of-pocket costs associated with Medicare Part A and Part B.

Members of these plans may see a group number on their card that corresponds with their coverage. Instead of being grouped by company as you might in an employer-sponsored plan, beneficiaries of private Medicare plans may be grouped by area and plan type.

Add Your Favorite Providers

Keep a list of all your favorite providers Select the button above to find and compare providers. Then, select the heart icon next to any of the providers to add them to your list of favorites.

If youre not already logged into your Medicare account, a window will pop up for you to log into your secure Medicare account. Once youre logged in, the provider will either automatically add to your favorites, or, if youre adding a favorite doctor or clinician, you can select the box to make this provider your primary clinician, select the location you use, and then Add to Favorites.

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Apply For A Provider Number Or Prescriber Number

How to apply for an initial Medicare provider number, Pharmaceutical Benefits Scheme prescriber number or additional provider numbers.

Most Medicare provider number applications are taking up to 15 calendar days to process from the date we get your application. Some applications may take longer if they need to be assessed by the Department of Health.

From 27 December 2021 to 4 January 2022 you wont be able to apply for a Medicare provider number through HPOS. The Australian Business Register will be unavailable at this time. If youre eligible to apply through HPOS, make sure you apply before or after this period.

How Do I Get One

There is no charge to get an NPI. Audiologists and speech-language pathologists can apply online for their NPI, free of charge, by applying online or by contacting the NPI Enumerator to request a paper application. It takes less than 5 minutes to apply online and the number is issued within a few minutes. Note: The provider type is 23 . The taxonomy number for audiologist is 231H00000X. The taxonomy number for SLP is 235Z00000X.

Clinical Fellows without a state license are to apply for an NPI as a student. Under the NPI system, a student is defined as “An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration and/or licensure to provide health care.” When the state license is conferred, the applicant will need to update their taxonomy code. The student taxonomy code is 390200000X.

For further information about obtaining an NPI, please visit the NPI page on the CMS website.

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How Do I Get My Medicare Number Online

You can find your Medicare Number online by logging into your Medicare.gov account and following the prompts to request a new Medicare card. Youll have the option to print out a copy of your card. This step will allow you to see your Medicare Number without having to wait until your card arrives in the mail.

Logging In As A Delegate

To cease acting on their behalf, select Stop acting button on the right hand side of the header

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Termination And Deletion Of Msp Records In Cms’s Database

Medicare claims paying offices can terminate records on the CWF when the provider has received information that MSP no longer applies . Termination requests should be directed to your Medicare claims payment office. MSP records that you have identified as invalid are reported to the BCRC for investigation and deletion.

Nominate A New Delegate

You and your delegates will get an expiry warning notification in your HPOS mailboxes before the delegation expires.

The Medicare website has information on managing HPOS delegations, including the services that delegates can access, and step-by-step instructions on how to:

• View transactions.
• Amend your delegates end date of access to services on your behalf.
• Approve a new delegation request or renewal.
• Delete or remove a delegate.

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What Is My Medicare Beneficiary Identification Number

Your Medicare Beneficiary Identifier number is for billing and identification purposes.

On a Medicare card received before 2015, your Medicare Claim Number consisted of your Social Security number followed by a code of letters and sometimes numbers that have a specific meaning.

In more recent years, a randomly-generated combination of letters and numbers replaced this Medicare Claim number.

Removing Social Security numbers from Medicare cards further protects the identities of Medicare beneficiaries. The replacement number is called the Medicare Beneficiary Identifier, or MBI number.

Moreover, if you still have a Medicare card with your Social Security number on it, you can still use it. Nonetheless, getting a new Medicare card is certainly in your best interest.

As you become Medicare savvy, see how much you can save on medical expenses by comparing Medicare insurance quotes for free with our free tool above! !

Manage Your Provider Numbers In Hpos

As part of managing your provider number you can update your details, apply for subsequent provider number locations or close a location.

This information was printed 23 December 2021 from https://www.servicesaustralia.gov.au/manage-your-provider-numbers-hpos-medicare-benefits-for-health-professionals. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/site-notices when using this material.

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Finding Your Medicare Provider Number

Here are some ways to find your number if you cannot locate your card:

• Visit or call your local Security Administration office to ask for a replacement card.
• Pull up some recent documentation that you’ve received from Medicare. Your number should be on the documentation.

If you request a replacement card, it will typically arrive by mail within 30 days of your request. It’s very important to always update your address and contact information any time you make a move because the information that is on your file will be used when sending replacement cards. It’s much easier to stay current with the Social Security Administration than it is to try to verify your identity in a pinch.

If you’re in a rush, your local Social Security office will be able to send you a letter stating your insurance status. It’s also possible to print out a copy of your Medicare card from your online Medicare account.

Access Patient’s Medicare Details With Proda

After logging in with PRODA, the Find a Patient service in HPOS lets you search and immediately confirm patient Medicare numbers, concessional eligibility, and details. This service is available to the following users through HPOS:

• The practice’s RO or OMO
• Delegated users
• GPs who have linked their Medicare Provider Number in HPOS. This number can be added into the My Personal Details section by clicking My Details in the main menu.

To use this service, select Find a Patient from the main menu. Follow the prompts and ensure the declaration is completed . There is a step-by-step guide on the HPOS website.

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Provider Transaction Access Number

A PTAN is a Medicare-only number issued to providers by Medicare Administrative Contractors upon enrollment to Medicare. MACs issue an approval/notification letter, including PTAN information, when an enrollment is approved.

PTAN and NPI RelationshipWhile only the National Provider Identifier is submitted on claims, the PTAN is a critical number directly linked to a provider or supplier’s NPI. A PTAN’s use should generally be limited to a provider’s communication with their MAC.

Multiple PTANs for Different Practice Locations May be AppropriateNoridian may determine and issue more than one PTAN depending only upon the reasonable charge locality of your practice locations. Unless the reasonable charge locality changes, additional PTANs will not be assigned.

Provider Not Eligible for a Medicare PTANRequests for a “denial only letter” are no longer accepted. Providers that are not eligible for a Medicare number must have the beneficiary submit the CMS-1490S form.

Inactive PTANs are DeactivatedMedicare is mandated by CMS to deactivate PTANs not being used. The deactivation process occurs every month. A provider’s PTAN is deactivated when he or she has not billed the Medicare program for four consecutive quarters. A PTAN is given an end-date when it is deactivated, meaning claims can get submitted prior to the end-date within a year of the service date.

Find my PTANThere are two options to find a provider PTAN.

National Provider Identifier Numbers

The Centers for Medicare and Medicaid Services requires that all health care providers, including audiologists and speech-language pathologists, obtain a National Provider Identifier . All health care providers and organizations are eligible to receive NPIs.

Getting an NPI is free not having one can be costly.

For more news and updates, go to the NPI page on the CMS website.

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Coba Trading Partner Contact Information

The Coordination of Benefits Agreement Program establishes a nationally standard contract between CMS and other health insurance organizations that defines the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. CMS has provided a COBA Trading Partners customer service contact list as an avenue for providers to contact the trading partners. The COBA Trading Partners document in the Download section below provides a list of automatic crossover trading partners in production, their identification number, and customer contact name and number. For additional information, click the COBA Trading Partners link.

How To Find My Medicare Provider Number

For individuals, the easiest way to find your Medicare provider identification number is to look on your Medicare card. The Medicare number format typically consists of your Social Security number followed by a special identifying code.

It’s also helpful to know what the “A” and “B” on your Medicare benefits signify. The A represents Medicare Part A benefits these are your inpatient hospital benefits. The B represents Medicare Part B this is the portion that covers you for outpatient medical benefits.

But what happens if you can’t remember your Medicare number? If you misplace your Medicare card at any point, you may be wondering if you can still locate your identification number.

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