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What Is My Medicare Group Number

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What Are Examples Of Other Insurance Policy Numbers

How To Find ð? Your Medicare Provider Number ð PTAN

Other insurance companies have set formulas for their policy numbers to make them easier to identify. For example, most Horizon NJ Direct policy numbers start with NJX3HZN followed by a unique group of numbers that are individual to you. Your group number will also be listed on this card.

Your policy number is typically listed on the front of your insurance card along with other basic information to verify your identity and eligibility for benefits.

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What Is My Member Id Number

What is insurance group number? Almost all insurance plans will assign you a member ID number, regardless of whether it is employer based or not. This number is individual to you specifically, whereas the insurance group number can apply to multiple people who have the same employer as you, as well as their dependents.

The member ID number is used to determine your coverage and eligibility for certain services. It is also used by your medical provider for billing purposes and by your insurer to look into claims and benefit information.

Is policy number the same as group number? No, policy number is specifically for your policy, but group number usually refers to your employer or group where youre getting your coverage. If you have no group number on your insurance card, that usually just means you arent receiving it through your employer.

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Not Sure If You Have An Npi

  • Information about relevant final adverse actions, which may include:
  • A Medicare-imposed revocation of Medicare billing privileges
  • A suspension, termination, or revocation of a license to provide health care by a state licensing authority or the Medicaid Program
  • A conviction of a federal or state felony within the 10 years preceding enrollment, revalidation, or re-enrollment
  • An exclusion or debarment from federal or state health care program participation by the Office of Inspector General or other federal or state offices with authority to exclude or sanction a provider
  • An application is the paper or electronic form you submit for Medicare Program enrollment approval. After the MAC processes the application, PECOS houses the enrollment record that includes all your enrollment application data.

    You can’t use PECOS to:

    • Change your SSN
    • Change a providers or suppliers TIN
    • Change an existing business structure, for example:
    • A solely owned Professional Association , Professional Corporation , or Limited Liability Company cant be changed to a sole proprietorship
    • A sole proprietorship cant be changed to a PA, PC, or LLC
  • Reassign benefits to an unenrolled PECOS provider
  • Submit changes noted above using the appropriate paper Medicare enrollment application.

    No. All Fee-for-Service providers can apply in PECOS.

    Even if you submit your application on a paper form, your MAC creates an enrollment record in PECOS.

    When to create a new enrollment:

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    Provider Enrollment Site Visits

    In 2011, CMS implemented a site visit verification process using a National Site Visit Contractor . A site visit is a screening to prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program. The NSVC conducts unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS suppliers. The NSVC may conduct an observational site visit or a detailed review to verify enrollment-related information and collect other details based on pre-defined CMS checklists and procedures.

    During an observational visit, the inspector has minimal contact with the provider or supplier and doesnt hinder the facilitys daily activities. The inspector may take facility photographs as part of the site visit. During a detailed review, the inspector enters the facility, speaks with staff, takes photographs, and collects information to confirm the providers or suppliers compliance with CMS standards.

    Inspectors performing site visits will carry a photo ID and a CMS-issued signed letter of authorization the provider or supplier may review. If the provider or its staff want to verify CMS ordered a site visit, contact your MAC.

    Make your office staff aware of the site visit verification process. An inspectors inability to perform a site visit may result in your Medicare enrollment application denial or Medicare billing privileges revocation.

    What Is Medicaid Policy Number

    Group Number On Insurance Card / What Is Medicare Surtax ...

    Your Medicaid number also known as a recipient number or individual number is a 9-digit number than can be found on the Your Texas Benefits card. Doctors and pharmacies use this number for billing. Your case number can be found on letters you receive from HHSC or you may also request it from a rep at 211.

    Read Also: Why Sign Up For Medicare At 65

    Im A New Member Is There Anything I Can Do Before I Receive My Member Id Card

    While youre watching the mail for your member ID card to arrive, there are a few things you can do while youre waiting for your coverage to start, including looking for network providers and learning how to register for a health plan account.

    How To Shop For Group Medicare Advantage Plans

    If your company offers you an EGWP, you may need to talk to the companys insurance representative. Some things to consider about EGWPs include:

    • Your insurance coverage needs. Be sure to consider the medications you take and doctors you see. This will enable you to see if the plan covers your prescriptions and providers.
    • The geographic area the plan covers. Look for hospitals and healthcare practices included in the network. Look for an in-network hospital near you in case you require immediate care.
    • The plans star rating. The Medicare Advantage Star Ratings program rates Medicare Advantage plans on a scale of up to five stars. Medicare Advantage considers plans that earn four or five stars to be high-quality.
    • Other Medicare Advantage plan options. Compare the EGWP plan to other available Medicare Advantage plans in your area by visiting If you have a specific question, you can also call 800-MEDICARE.

    Since insurance companies tailor EGWPs to each business, union, or government entity, you may be able to do most of your research through the insurance company that provides the plan and the benefits office at your company.

    Read Also: What Is A Good Secondary Insurance To Medicare

    Where Can You Find Your Medicare Claim Number

    • Your Medicare claim number, or Medicare Beneficiary Identifier is an 11-character number Medicare uses to identify you. Learn how to find your number and how to use it to file a Medicare claim or track your Medicare claim status.

    On the front of your Medicare card is a number that is 11 characters long, consisting of numbers and uppercase letters. This is your Medicare claim number, also referred to as a Medicare Beneficiary Identifier .

    To avoid confusion between letters and numbers, Medicare does not use the letters S, L, O, I, B or Z. So if your Medicare claim number contains an O, it is the number 0 and not the letter O.

    Medicare previously used a persons Social Security number to file claims. But over the course of 2018 and 2019, Medicare issued new cards to all beneficiaries with a randomly assigned number that is unique to each person. This was done to help protect the personal identifying information of Medicare beneficiaries and to help minimize identity theft and other forms of fraud.

    If you have lost your Medicare card, log into to print another temporary copy. You may also call 1-800-MEDICARE and follow the prompts for help replacing a lost or stolen card.

    Denial Of Ordering Or Certifying Claims

    How to Access Your Medicare Number Online

    If claims lack a valid individual NPI, MACs deny them if they are:

    • Claims from clinical laboratories for ordered tests
    • Claims from imaging centers for ordered imaging procedures
    • Claims from DMEPOS suppliers for ordered DMEPOS
    • Claims from Part A HHAs that aren’t ordered or certified by a Doctor of Medicine , Doctor of Osteopathy , or Doctor of Podiatric Medicine

    If you bill a service that needs an eligible provider and one isnt on the claim, the MAC denies the claim. The claim must have a valid NPI, and the eligible providers name as it appears in the PECOS.

    If a provider on the Preclusion List prescribes a drug, Part D plans deny Part D covered drugs.

    Read Also: When Can I Apply For Medicare In California

    Requirement : You Must Have An Individual Npi

    There are 2 types of NPIs: Type 1 and Type 2 . Medicare allows only Type 1 NPIs for solely ordering items or certifying services. Apply for an NPI in 1 of 3 ways:

  • Online Application: Get an Identity & Access Management System user account. Then apply in the National Plan and Provider Enumeration System for an NPI.
  • Paper Application: Complete, sign, and mail the NPI Application/Update Form paper application to the address on the Enumerator form. To request a hard copy application, call 1-800-465-3203 or TTY 1-800-692-2326, or email .
  • Bulk Enumeration: Apply for Electronic File Interchange access and upload your own comma-separated values files.
  • How Do You Look Up Your Medicare Number

    Medicare numbers can be found on Medicare cards and also on much of the correspondence from the Social Security Administration or the Medicare provider. Medicare numbers can also be obtained by visiting a local SSA office or by calling the Medicare provider and establishing the members identity.

    A Medicare number includes a persons social security number followed by a small code that consists of letters or letters with numbers depending on various factors. It is also called a Medicare claim number on documents from the provider. Because the number is primarily made up of a persons social security number, it is not easy to look it up if lost or forgotten.

    Recommended Reading: Do Walk In Clinics Take Medicare

    Sole Proprietorships And Disregarded Entities

    For more information about sole proprietorships and disregarded entities, refer to the Medicare Program Integrity Manual Chapter 15, Section 15.2 and 15.5.5 , respectively.

    Medicare participation means you agree to accept claims assignment for all Medicare-covered services to your patients. By accepting assignment, you agree to accept Medicare-allowed amounts as payment in full. You may not collect more from the patient than the Medicare deductible and coinsurance or copayment. The Social Security Act says you must submit patient Medicare claims whether you participate or not.

    To participate as a Medicare Program provider or supplier, submit the Medicare Participating Physician or Supplier Agreement upon initial enrollment. Youve 90 days after your initial enrollment approval letter is sent to decide if you want to be a participating provider or supplier. The only other time you may change your participation status is during the open enrollment period, generally from mid-November through December 31 of each year.

    Participating Provider or Supplier

    • Medicare pays 5% more to participating physicians and other suppliers
    • Because these are assigned claims, Medicare pays you directly
    • Medicare forwards claim information to Medigap insurers

    Non-Participating Provider or Supplier

    For more information, refer to the Medicare Claims Processing Manual, Chapter 12.

    What Is A Health Insurance Group Number

    Aetna Digital Id Card

    A group number is assigned to the employer or other group that sponsors an insurance plan for its employees or other individuals covered by the group plan. Each member of the group will share the same group number, but each person will have their own unique member number.

    A group number helps identify the benefits provided by the plan and is used by health care providers in the billing process.

    Group numbers are generally only used for employer-sponsored plans or other group plans. Individual plans purchased directly from an insurance carrier or through the health insurance marketplace typically do not have a group number because they are not tied to any employer or group.

    Nearly all insurance plans will assign members an individual member ID number, however. The member number can be found on your insurance card and may also be referred to as a policy number.

    Also Check: Does Medicare Cover Hospital Bills

    How Do You Get Another Medicare Card

    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

    Who Is An Npp

    NPPs include nurse practitioners, clinical nurse specialists, and physician assistants who practice with or under the supervision of a physician.


    • Mass Immunization Roster Billers, individuals
    • Nurse Practitioners
    • Occupational/Physical Therapists in private practice
    • Physicians
    • Physician Assistants
    • Registered Dietitians or Nutrition Professionals
    • Speech-Language Pathologists

    Clinics/Group Practices and Specific Suppliers

    • Ambulance Service Suppliers
    • Independent Diagnostic Testing Facilities
    • Intensive Cardiac Rehabilitation Suppliers
    • Mass Immunization Roster Billers, entities
    • Opioid Treatment Programs
    • Physical/Occupational Therapy Group in Private Practice
    • Portable X-ray Suppliers

    Read Also: What Insurance Companies Offer Medicare Supplement Plans

    Group Health Insurance Plans

    Group health covers typically offer Insurance coverage on employer-sponsored health plans as part of the employee benefits package on offer.

    Group health coverage isnt a law requirement to contribute plan premiums. Several insurance companies necessitate employers to pay 50 percent of the required premiums. State and federal laws differ on size and nature of a group plan.

    What Is My Medicare Beneficiary Identification Number

    How Your Group Plan and Medicare Work Together

    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! !

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    Is Group Number The Same As Policy Number

    Your policy number on your health insurance card will not be the same as your group number. The policy number on health insurance refers to your individual member number, but the group number is different. Normally, your group number refers to your employer or where you get your insurance coverage from.

    What Other Important Information Is Listed On My Health Insurance Card

    There are several other pieces of information that may be present on your health insurance card. Some of the basics include your name and the name of your insurance company, as well as a phone number to contact them at.

    If the health insurance policy is under someone elses name, such as your spouse or parent, their name be present on the insurance card, as well.

    You may also see the name of your specific plan on your card, which can be helpful if you need to call customer service, as they will likely ask which plan youre enrolled in.

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    Providers Who Solely Order Or Certify

    Recent legislation says physicians and other eligible professionals must enroll in the Medicare Program or have a valid opt-out affidavit on file to solely order or certify Medicare patient items or services.

    Those physicians and other eligible professionals enrolled solely as ordering or certifying providers don’t send billed service claims to a MAC.

    Multiple Employer Welfare Arrangement Plans

    Aetna Medical Id Card

    A Multiple Employer Welfare Arrangement is a medical insurance plan offered by several organizations that have connected collectively, to provide health coverage to their respective employees. The MEWA health plan schemes are regulated by the U.S. Labor Department and the local government authorities.

    The collective MEWA plans must be licensed by the local government unless a certified health insurance company assumes the entire employees MEWA liability.

    Employees are provided with a health card to access medical services in the selected hospitals within their designated locations.

    The individual cards have both a group policy number as well as an individual policy number for referencing and billing purposes.

    Recommended Reading: Which One Is Better Medicare Or Medicaid

    Where Can I Find My Policy Number And What Is It

    Your health insurance policy number is typically found on the front of your insurance card. This number is unique to you and it is used to identify your plans benefits and the services that you are eligible for. Your medical provider will use this number for billing purposes, as well as to verify your plan.

    If you need to contact your health insurance provider, you will usually need to give this number to the customer service representative to ask any questions about your plan.

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    Getting Your Medicare Card

    You get a Medicare card when you enrol in Medicare. Well send you your card in 3 to 4 weeks. Well send it to the address you give us.

    You can use a digital copy of your Medicare card as soon as you enrol. To use a digital version of your Medicare card, you need to:

  • Sign in to the Express Plus Medicare app.
  • Select the Card tab on the homescreen.
  • To access the app, you need a myGov account linked to your Medicare online account. If you dont have these, youll need to set up your Medicare online account before you can download the app.

    You can only be on 2 Medicare cards at the same time. Once youre 15 years or older you can get your own Medicare card. Read more about your Medicare card.

    Recommended Reading: What Is Medicare In Simple Terms

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