Be Prepared When Calling CMS Customer Service

Very soon you won’t be able to make inquiries to the Centers for Medicare & Medicaid Services’ (CMS) interactive voice response (IVR) system or a customer service representative (CSR) without some very specific information.

Effective April 6, CMS will require caller verification with ALL three of the following data elements:

  • Provider’s National Provider Identifier (NPI)

  • Provider Transaction Access Number (PTAN)

  • Last 5-digits of the provider’s tax identification number (TIN)

The caller gets three attempts to provide the correct NPI, PTAN, and last 5-digits of the TIN. Without the proper provider authentication, the Medicare contractor’s system will not supply the information requested.

CMS Change Request 6139 was issued Feb. 10 to update the new provider confirmation requirement’s effective and implementation dates. For more information on the new requirement, read the Medicare Learning Network (MLN) article, MM6139, on the CMS Web site.


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16 Responses to “Be Prepared When Calling CMS Customer Service”

  1. Juanita Mendoza says:

    FYI – don’t know if you already knew this.

  2. MERRIE GAIK CPC says:

    I know that we are all required to properly identify parties that we are talking with. I am not sure why we now have 3 numbers that can identify us as providers. Orginally I thought our Tax ID was to do this then UPIN was introduced, now PTAN,then all providers had to apply for a NPI which also identified us. What’s next? How many more numbers are we going to required to have??

    Merrie Gaik, CPC

  3. Mary Caouette,CPC says:

    Medicare made this big production about just having NPI numbers as the provider number and now when we call after April 6, 2009 there are going to want NPI, PTAN and last 5 digits of Tax ID number. Why did Medicare have us apply for NPI numbers when they still want all the other numbers. This makes no sense. Thank you

  4. Cheryl Spencer says:

    We, also, were under the understanding that the NPI was going to “replace” all other provider identifying numbers. It seems now that it has just “added to” the provider identifying numbers that we already have. Such nonsense.

  5. Paula Rietel says:

    I agree we were told the NPI was going to replace all other provider numbers. also is it just me or does everyone else get tired of automated everything what ever happend to talking to a live person

  6. Karen Wolmer says:

    Actually, I’ve given up calling. The issues are practice is facing is the “manage care” Medicare products. I found that using Navinet to confirm eligibility for Medicare patients is much easier than calling and the website provides us with helpful information as to what plan the patient is on. Of course, you still need to have access the that plans website to obtain the patients id number but it has eliminated the calls to Medicare. If it is a coding issue, I located the LCD on NGS website and compare it to the claim. Being a CPC with knowledgable physicians is a plus. It has decreased our time spent in follow up substancially.

  7. Brenda Clements says:

    Regarding the Medicare Advantage Plans. I feel we have been mislead. At one of the Medicare Meetings we were told that we did not have to be credentialed with these plans. The rule was that if we already participated with Medicare we would automatically be signed up with the Medicare Advantage Plans. Well this is not the case. We have since found that there are HMO Advantage Plans and patients who go to providers that have not signed up with these plans are being denied their claim because they went out of network.
    It would be less complicated if we all were told the true facts on these rules instead of being told something different each time we call or go to a meeting.

  8. Kelly Randell says:

    Can we add the bar code! LOL This is ridiculous, just another way to impede the payment process.

  9. Jill Gibson, CPC says:

    I agree with all that is said, I have been coding for 12 years and Medicare/Medicaid changes all the time. you just have to get use to it and not let it bother you, cause they are the government and we have to live with it. What they say goes. and they don’t have to follow any rules, they make up their own….Everyone Have A Great Day!

  10. Jennifer Haney CPC says:

    I just found out that the Navinet Medicare eligibility verification is only a “free trial”. As of 3/31/09 you will have to pay $7 per provider per year to keep your access to Medicare through Navinet.

  11. Charlene Soares says:

    I too find the NPI a hugh annoyance. It was suppose to take the place of all the provider numbers required for ALL the different insuance companies. Ha Ha! They still want your Tax ID, your legacy provider number and your NPI. We had to take the ‘legacy’ provider numbers out of our system as they did not want it going on any forms or electronically. So trying to readily have all the old legacy numbers has become another thing to keep track of that is not in the database as it had been before the NPI. Then there is coordinating with the clearinghouse crosswalk. Then Blue Shield seems to change their system requirements whenever they want to resulting in a proctice that was going along fine and then sudden rejections. When you call them they blame the clearinghouse and then the clearinghouse blames the insurance company. It’s all crazy. This is the biggest mess I’ve seen in 30 years. When will it end?

  12. Kim Sagely says:

    I have a grid posted on the wall beside my monitor with all my providers #s–NPI, PTAN, BCBS, Mediciad, RRMedicare, and RRMedicare PTAN. It is the only way I can navigate through the systems. I used to have the Medicare automated systems memorized as far as what options to enter. But that doesn’t really work anymore–it changes all the time. We use MedData to verify Medicare eligibility as it will give you the replacement plan info, if there is one. Problem is that it gives you the plan name and plan number, which is not the id number. These independent contractors that go out to communities, or door to door, often don’t explain the rules of the new HMO replacement plans and these folks aren’t even aware that they need a PCP or that they have to see in-network providers or that their benefits are different. It has made the system so much more complicated.

  13. joanie says:

    this is only he beginning of the mess if the government starts to play a bigger role in healthcare. they can’t get the fraud and abuse under control now. How are they going to add or create a bigger system when this one is so out of control? If you ask me, NPI was just another way to punish the doctors or lead them to make less because of the rules that are always changing. Medicare & Medicaid are the worst in line when it comes to being “standard.”

  14. Pawan Arya, MBA, CPC, CPC-H says:


    That was good one – bar code should be next and may be further down finger prints of the caller should be on file. LOL.

    But more seriously –

    Medicare is slowly becoming worst nightmare. Instead if simplifying procedures, they are being made more complicated.

    I agree, using if all these numbers to ID, what was use of having NPI.

    No more you can speak to a Medicare rep. If at all you do, they are not helpful and direct you to web. Then why at all do they need live rep on payroll.

    Credentialing procedures have become more complicated. If there is an error, they simply send the entire package back and worse stamp it and you need to start all over again.

  15. Teri Murphy, CPC-I says:

    Medicare Advantage Plans need to train their sales staff, to underestand their product. I feel the elderly have been mislead. Most of the patient’s done understand their coverage. We have a local Medical Managers Group. We asks the representative from Humanna to come explain their benefits and guidelines to us, so we could help their insured. The sales rep was not able to answer the majority of our questions. She was asks if it was necessary to obtain an (ABN) Advanced Beneficary Notice for procedures, as we often do for Medicare. She did not have a clue what an ABN was. She tells patients they still have traditional Medicare and the Medicare Advantaged plan both. Leading them to believe that is the Advantage plan does not cover a procedure, Medicare will cover it.

  16. Erin Toavs, CPC says:

    Not only do the Medicare “Customer Service” reps get the “least helpful of the day” awards, but they are now all under the impression that it is their policy to not give out any claim denial reasons over the phone. They direct you to your remittance, and if you don’t have the remittance, they offer to mail a copy. I’m still waiting for my copy from 2 months ago =)

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