What is the Ptan Request For Railroad Medicare form used for?
This form is specifically designed for electronic claim submitters who need to obtain a Provider Transaction Access Number (PTAN) for Railroad Medicare. Only providers who have delivered services to a Railroad Medicare beneficiary should use this form. It facilitates the electronic submission of claims for up to five providers, ensuring efficient processing of requests.
What information is required to complete the form?
You must enter several details on the form, including your legal business name, tax identification number, payment address, and practice location. You will also need to provide your individual NPI, group NPI, and the local MAC PTAN associated with each provider. Ensure that all information is complete and accurate before submitting to avoid delays.
Can I submit changes to my existing Railroad Medicare PTAN using this form?
No, this form is not intended for submitting changes to existing PTANs. It is strictly for new requests or for providers who are not already enrolled. If you need to make changes to an existing PTAN, you should contact your local Medicare Administrative Contractor (MAC) directly for the appropriate process.
How many providers can I include on one form?
You can list up to five providers on a single form. If you have more than five providers for whom you need PTANs, you will need to complete additional forms. This ensures that each provider’s information is processed correctly and efficiently.
Where do I send the completed form?
Once completed, you should fax the form to (803) 382-2417. Make sure the form is fully filled out prior to faxing to avoid processing delays. Providing accurate information will help expedite your request for a Railroad Medicare PTAN.