Effective Date of Reactivation

In accordance with Centers for Medicare & Medicaid Services (CMS) instructions, providers who reactivate their billing privileges after their Provider Transaction Access Number (PTAN) has been deactivated for twelve months of inactivity are assigned a new PTAN. This ensures that their billing privileges do not become subject to a second deactivation for non billing within 30 days of the reactivation. The effective billing date for the new PTAN assigned for reactivation is determined as follows, depending on the specialty of the provider.

  1. For physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, clinical social workers, clinical social workers, clinical psychologists, registered dietitians/nutrition professionals, and organizations/group practices of these individuals:
    The effective billing date for the new PTAN is the later of the filing date of the Medicare enrollment application for reactivation, or the date the provider first started furnishing services at the practice location indicated on the application.

    There is an exception, however, for providers who have at least one other enrolled practice location under the same tax identification number for which the provider is currently billing Medicare. In this case, the effective date for the new PTAN is the later of the date the provider first saw a Medicare patient at the location indicted on the application, or the same date as the non billing end date on the deactivated record.

  2. For independent diagnostic testing facilities (IDTFs): The effective billing date for the new PTAN is the later of the filing date of the Medicare enrollment application for reactivation, or the date the IDTF first started furnishing services at the practice location.

  3. For all other providers: The effective billing date for the new PTAN is the later of the date the provider first saw a Medicare patient at the practice location indicated on the application, or the same date as the non billing end date on the deactivated record.

In each case, there may be claims for services provided on dates of service that are not payable by Medicare under either the original, deactivated PTAN or the new PTAN assigned for reactivation.

If it appears that an error may have been made in the effective billing date determination, providers should contact our Provider Enrollment Department. A correction will be made if the effective billing date was not determined in accordance with CMS instructions.

Note: All claims for services provided to Medicare beneficiaries must be filed within 12 months of the date of service.

Page Last Updated: Friday, 10-Feb-2012 07:42:34 CST