Saturday, June 15, 2024

How To Get A Medicare Number As A Provider

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Other Ways To Obtain A Medicaid Provider Number

How To Find ð? Your Medicare Provider Number ð PTAN

The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2. Atlanta, Chicago and New York are just a few to mention. If you want to enroll in the Medicare provider services program in person, go to the nearest regional office.

Any questions related to the enrollment process and other services can be communicated by phone 2. For example, if you have general questions about the program, you may call 800-633-4227, the Medicaid phone number. Another option is to access, select Contacts Database and search for a Medicaid office for a Medicaid customer service representative in your area.

Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state. Signatures must be handwritten. The application forms are available on the website under the Enrollment Applications section.

  • The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2.
  • Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state.

Submit The Following To The Fiscal Intermediary

The Provider/Supplier Enrollment Application Form is a requirement of the application process. To obtain this form, click on the CMS-855 link above or call the fiscal intermediary at 696-0705 or visit their website at The CMS-855A form, along with its required documentation, and proof of payment of the application fee, are to be returned directly to Palmetto GBA, not ODH. ODH cannot process your application until this approval has been received from the Fiscal Intermediary. It may take up to 6 months for ODH to receive this approval.

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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How To Become A Medicare Provider


Whether you are a practitioner or own a health care service such as a nursing home, home health agency, hospice or durable equipment supply company, you must complete a multiple-step process to bill Medicare for the products and services you provide to patients. Becoming a Medicare provider also opens doors to new patients who rely on the benefits to cover their health care needs. As the baby boomer population ages, the ability to accept Medicare becomes an increasingly important way to continue providing services to your patients.

Completing The Medicare Provider Enrollment Process

Billing: Make Sure Youre Ready For New Medicare Cards

This article will outline some of the key steps in the Medicare enrollment process for a single physician, John James MD, starting a new practice. This enrollment example assumes the physician has formed a legal business entity under which he will practice, XYZ, LLC. This example illustrates using the paper application process, and highlights sections that would cause an application to be denied if not fully completed.

Overview of forms needed:

  • CMS855I Medicare Enrollment Application Physicians and Non-Physician Practitioners
  • CMS460 Medicare Participating Physician or Supplier Agreement
  • CMS588 Electronic Funds Transfer Authorization Agreement
  • Supporting Documents Required:

  • CP575 or Letter 147C from the IRS to verify the tax id# of the business
  • Pre-printed voided check, or a bank letter of account verification, that exactly matches the legal business name on the IRS CP575 or letter 147C.
  • Dr. James will need to obtain a Medicare number, referred to as a Provider Transaction Identification Number or PTAN, for both himself and his legal business entity. This will allow all payments from Medicare to be made to his business under the business tax id#. Since Dr. James is the sole owner of XYZ, LLC, he can obtain both the Group PTAN and his Individual PTAN using the individual enrollment application CMS855I. The CMS855I contains 17 sections and 27 pages.

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    Access Patient’s Medicare Details With Sha

    SHA-2 is a security certificate for installing on your computer. Once installed, staff can securely access HPOS without having to log in. With SHA-2, the only function available is to check Medicare numbers and expiry dates . So there is less functionality than via PRODA, but SHA-2 is quicker and more convenient.

    Once installed, staff simply need to go to and click the Access HPOS and Digital Health Services with PRODA or PKI PKI Certificates button.

    What Does Medicare Cover

    Check if Medicare covers your test, item, or service. Or, download our “What’s covered?” mobile app to your smart phone or tablet to quickly find covered services. If something isn’t covered, talk to your doctor or other health care provider about why you need it.

    Medicare covers services that are medically necessary.

    • Part A helps cover inpatient care in a hospital, skilled nursing facility care, hospice care, and some home health care.
    • Part B generally helps cover:
    • Services or supplies needed to diagnose or treat your medical condition .
    • Preventive services to prevent illnesses or detect illnesses early . You pay $0 for most preventive services if your provider accepts the Medicare-approved amount as full payment.

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    What Is Section 19ab

    Section 19AB of the Act restricts Overseas Trained Doctor or Foreign Graduate of an Accredited Medical School from accessing Medicare benefits arrangements for a period of generally 10 years from the date of their first Australian medical registration. These restrictions are referred to as the the 10-year moratorium.

    How Do You Get Another Medicare Card

    Medicare Provider Enrollment Through PECOS

    My card is lost or damaged Log into your Medicare account to print an official copy of your Medicare card. You can also call us at 1-800-MEDICARE to order a replacement card. TTY users can call 1-877-486-2048.

    My name changed Your Medicare card shows the name you have on file with Social Security. Get details from Social Security if you legally changed your name.

    Protect your identity

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    Does My Doctor Or Provider Take Medicare

    If you have:

    Do this:

    Original Medicare

    Before you get services, ask your health care provider if they charge the Medicare-approved amount .

    • If they do, you wont be billed for more than the Medicare deductible and coinsurance.
    • If they dont, they can charge you more than the Medicare-approved amount. You might have to pay the full cost at the time of service.

    Medicare Advantage Plan

    Check with your plan to find out if they have a network and if your provider is in-network.

    • Some plans allow you to use providers out-of-network, but you usually have to pay a higher share of the costs.
    • You can always get emergency care and urgent care when needed, even if the doctor or hospital isnt in-network.

    Medicare drug coverage

    Check with your plan to find out what pharmacies in your area are in-network. In-network pharmacies are preferred or standard.

    • Preferred pharmacies usually offer the lowest cost for drugs.
    • If you use an out-of-network pharmacy, you might have to pay the full cost.

    If you need or get help with costs, have Medicaid, or have a disability, find programs and resources to help you with your Medicare coverage.

    Write To Insurance Companies

    You may write your insurance companies with questions that you have about your coverage. If possible, type up your letter and make sure to keep a copy that indicates the date on which you mailed it.

    If you arent able to type up your questions, make sure to write in clear, concise print, leaving plenty of space in between your questions. Be sure to include your contact information in any correspondence that you mail to your healthcare provider.

    Before sending mail that contains important documents or your private health information, call ahead and make sure that you have the correct contact information. Mail that is sent to the wrong address is not always forwarded to the right place, especially in places that receive a high volume of mail.

    Addresses for major insurance companies that provide Medicare policies:

    Aetna Inc.

    If your ability to talk on the phone is limited because of a health condition, you can still reach out to Medicare. TTY users can call 1-877-486-2048 to reach a hotline compatible with their devices.

    Centers for Medicare & Medicaid ServicesOffices of Hearings and Inquiries 7500 Security Boulevard, Mail Stop S1-13-25Baltimore, MD 21244-1850

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    Spousal And Discretionary Exemptions

    For the spousal and discretionary exemptions, we do an initial assessment before you can apply for a Medicare provider number.

    To apply:

    Can I Be Exempt From Working In A Dws

    Medico Insurance Phone Number

    There are a number of considerations for section 19AB exemptions, which include:

    • After-hours Exemption: the after-hours period is considered DWS Australia-wide for all medical specialties. As such, you would generally be able to obtain a section 19AB exemption to access Medicare benefits during the after-hours period anywhere in Australia. The after-hours period is defined by the Department as:
    • 6pm to 8am Monday to Friday and
    • All day Saturday, Sunday and Public Holidays.
    • Locum Exemption: you may be eligible for a section 19AB exemption to access Medicare benefits in a non-DWS location for a maximum of 6 months. You would not be able to work at that particular location beyond the 6 months while you remain subject to section 19AB.
    • Replacement Provision: you may be able to replace a restricted medical practitioner who held a section 19AB exemption and ceased practising in the local area within the last 12 months.
    • Spousal Exemption: you may be granted access to Medicare benefits in a non-DWS area if your spouse is accessing Medicare benefits in the local area, or is a skilled migrant who is employed in an occupation which is listed on the Short-term Skilled Occupation List or the Medium and Long-term Strategic Skills List .
    • Academic Provision: if you have been offered an academic appointment with an Australian medical school, you may be eligible to access Medicare benefits at the university health clinic that is tied to the academic institution.

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    Complete The Enrollment Application

    The next step in becoming a provider requires completing an enrollment application. Institutional providers such as home health agencies, hospices and outpatient physical therapy services must fill out CMS 855A, also known as the Medicare Enrollment Application for Institutional Providers. If you sell medical equipment or supplies, fill out CMS 855S, referred to as the Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Suppliers.

    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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    Submit Your Application Online

    If you wish to apply online, access the website. Check the Medicare enrollment resources for providers and then head over to the PECOS section 2. Before filling out your application, it’s necessary to register for a national provider identifier. All health care providers based in the U.S. are required to have this unique identification number.

    If you already have a national provider identifier, you can apply for a Medicaid provider number right away. Simply create a user account and fill out the enrollment form. You will need to provide an email address, enter a password and confirm your identity. Your application will be approved or declined within 45 days. Paper-based enrollment, on the other hand, takes about 60 days.

    • If you wish to apply online, access the website.
    • Before filling out your application, it’s necessary to register for a national provider identifier.

    Register For The Healthcare Identifiers Service

    PECOS Enrollment Tutorial â Initial Enrollment for an Individual Provider

    The Healthcare Identifiers Service is a national system that uses a unique number to match healthcare providers to individuals.

    If youre an individual healthcare provider registered with the Australian Health Practitioner Regulation Agency youll automatically get a healthcare identifier.

    If youre practising in a healthcare profession thats not regulated by AHPRA youll need to apply directly to the HI Service to get a healthcare identifier.

    Read more about applying for a healthcare identifier.

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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.

    Section : Individuals Having Managing Control:

    This section must list the name and identifying information of Dr. James. Dr. James would also need to make an additional copy of this page for an office manager or any other person who is responsible for managing the business of the practice.

    The Remaining sections of the 855I form include providing information on your billing company if applicable, contact information for the person completing the enrollment form, and signatures for the application. In addition to the 855I, Dr. James will submit a form 460 to elect participation in the program. The 460 is a simple one page form. The final form to be submitted is form 588 to establish Electronic Funds Transfer for payment. The CMS588 is a simple one page form of information and signature on page 2.

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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.

    How To Find My Medicare Provider Number

    New Medicaid Card

    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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    Can I Call Medicare For Help With My Coverage

    You can call Medicare anytime for help with your coverage. The number to call is 1-800-MEDICARE . The TTY number is 1-877-486-2048.

    This phone number is meant to be a general resource for questions you have about your Medicare coverage. You can check the status of your claims, inquire about your premium and deductible costs, and more.

    Here are other important phone numbers for issues relating to Medicare benefits:

    • Your State Health Insurance Assistance Program can give you personalized counseling as you choose the Medicare and health insurance options that are right for you. These programs give advice based specifically on the state in which you live. The SHIP national hotline is 1–701-0501.
    • To report a lost Medicare card or if you are trying to change your address with Medicare, you may need to call the Social Security Administration office. Their national hotline is 1 772-1213.

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