Last Modified: 4/10/2024
Location: FL, PR, USVI
Business: Part A
If you’re a Part A provider with multiple facility PTANs linked to a single NPI for your Medicare claims, First Coast has implemented a new process to match the most appropriate PTAN to your facility NPI in the claims processing system. With this enhancement, we’ll no longer issue you development letters requiring you to tell us in writing which PTAN to use for payment for the reported NPI.
Medicare requires claims to contain NPIs to be accepted for adjudication. NPIs reported on the claims are linked to the Medicare-assigned PTAN. Adjudication is based on a one-to-one relationship between the two. When a unique match cannot be made, claim development or returns may occur.
To reduce your burden, we implemented a new process that will result in less claim development and delays. The claims processing system first attempts to narrow down the universe of possible PTANs for an NPI based on a comparison of the address reported on the claim and type of bill.
When the claim processing system cannot identify a unique PTAN to NPI combination for a facility NPI, the first PTAN listed on the 4C screen in FISS will be listed on the claim to allow the provider to see the request.
For example:
• NPI 888888888 is associated with PTANs 222222 and 111111
• If a unique match cannot be identified, the first PTAN listed on the 4C screen for the NPI will be used to process the claim
• If PTAN 222222 is listed first, that PTAN will be used to process the claim
First Coast recommends using a one-to-one match. While we understand the necessity of having more than one NPI, if your enrollment dynamics permit the use of one single NPI to one PTAN, then you will avoid possible return to provider (RTP) claims. This can be done for all facility locations under one single Tax Identification Number (TIN).
Example of one-to-one match for a location to NPI association:
• Facility 1, Facility PTAN #1 – NPI #1
• Facility 2, Facility PTAN #2 – NPI #2
• Facility 3, Facility PTAN #3 – NPI #3
While not required, this approach would reduce the need for clarification. All claims for each location would pay to one single PTAN/NPI combination in the system.
• The claim will suspend, and a claims processor will review the claim to see if a PTAN is listed in the remarks section
• The claim will show reason code 77777, and there will be a notation in the remarks section requesting the correct PTAN
• The provider can simply add the correct PTAN in the remarks field, and send the claim back to First Coast
• If there are multiple locations, enter the PTAN of the correct location in the remarks field on the claim upon initial submission to expedite the claim process
• Keep enrollment records up to date with current billing and physical addresses for the location in which the PTAN is intended
• Ensure PTANs are end-dated when they are no longer in use
• Ensure the zip code (including the plus-four codes) is submitted on the claim and matches the zip code on file in PECOS for the NPI submitted on your claim
• If you have more than one PTAN to one NPI, each PTAN needs to have its own zip code (including the plus-four codes) to ensure claim accuracy, so please have one NPI per location
If your claims continue to return or deny for provider information after following the tips above, please contact our Part A Provider Contact Center at:
• Florida and U.S. Virgin Islands: 888-664-4112
• Puerto Rico: 877-908-8433
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.