Getting Started With Railroad Medicare Billing
If you are a Medicare-enrolled provider, you are eligible to render services for a Railroad Medicare beneficiary, but you must be assigned a Railroad Medicare Provider Transaction Access Number (PTAN) before Railroad Medicare can process your claims. If you have recently provided a Part B service to a Railroad Medicare beneficiary and are ready to submit your claim, follow these easy steps to request a Railroad Medicare Provider Transaction Access Number (PTAN) and start billing:
Step 1: Ensure your enrollment information is correct with your local Part B Medicare Administrative Contractor (MAC)
Before billing Railroad Medicare, you must be enrolled with and have a Provider Transaction Access Number (PTAN) for your local Part B MAC. Because Railroad Medicare’s enrollment records will match what your local MAC has on file, please make sure your enrollment information is current with your MAC before requesting a Railroad Medicare PTAN. If at any time your enrollment status with your local Part B MAC changes (such as failure to revalidate, provider revocations, provider suspensions, etc.), the same activity will occur with your Railroad Medicare PTAN.
Step 2: Request a Railroad Medicare PTAN
For electronic submitters:
Request a PTAN using the Railroad Medicare PTAN Lookup and Request Tool at www.palmettogba.com/RR/PTAN. Allow 30 calendar days for processing and return to the tool to retrieve your PTAN information. To learn more, please see our article Using Railroad Medicare’s Online PTAN Lookup and Request Tool.
If the provider information you enter on the tool does not match what your local Part B MAC has on its enrollment file, Railroad Medicare will not be able to complete your request.
Provider Enrollment does not accept telephone requests to assign a PTAN.
For paper submitters:
If you meet an exception to mandatory electronic filing, you can submit your initial paper claim(s) to obtain a Railroad Medicare PTAN.
Once Railroad Medicare receives a CMS-1500 (02/12) form, we will obtain your enrollment data from your local MAC and issue you a Railroad Medicare PTAN if everything can be verified on the MAC’s file, including the Tax Identification Number (TIN) (item 25), billing name and billing address (item 33). If the claim documentation is incomplete or cannot be verified, you will receive a letter stating that your request cannot be completed.
Step 3: Receive your Railroad Medicare PTAN
After we authenticate your information with the local MAC’s provider enrollment file, we will send you a letter detailing your Railroad Medicare PTAN data. If you requested your PTAN via the Railroad Medicare PTAN Lookup and Request Tool, you can also access your new PTAN through the tool and download a PDF file with your PTAN details. The effective date of your Railroad Medicare PTAN will be the same as the effective date on your local Part B MAC enrollment record.
Step 4: File Electronically
The Administrative Simplification Compliance Act (ASCA) prohibits Medicare payment of claims submitted on paper, with limited exceptions. The most common exceptions are small providers (physicians, practitioners, facilities or suppliers with fewer than 10 full time equivalent (FTE) employees) and roster billers of vaccinations. Even if you qualify for an exception, Medicare strongly encourages you to submit claims electronically.
To start electronic billing, please visit the Electronic Data Interchange (EDI) portion of our website at www.PalmettoGBA.com/rr and download our Railroad Medicare EDI Enrollment Packet.
Step 5: Go Green — Electronic Remits
Electronic Remittances can be requested by selecting the appropriate box on the Railroad Medicare Part B EDI application. The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Remittance Easy Print (MREP) software that allows you to view and print 835 Electronic Remittance Advices. If you requested a receiver ID, you may click the download form for MREP Software to install. If you are using a clearinghouse/billing service to receive your electronic remittances, please contact your clearinghouse/billing service. For technical assistance, please call our Provider Contact Center at 888-355-9165. Choose option 2 for EDI.
Additionally, when you are newly enrolled in the Railroad Medicare program or making changes to your existing enrollment records, you will begin receiving Electronic Fund Transfer (EFT) payments for claim payments. EFT allows a financial institution to deposit Railroad Medicare payments directly into a designated account. Once you have been established to receive funds EFT, you will no longer be eligible to receive your Railroad Medicare payments via paper checks.
If you have any questions along the way, please call our Provider Contact Center at 888-355-9165. Representatives are available from 8:30 a.m. to 4:30 p.m. in all time zones with the exception of PT, which receives service from 8 a.m. to 4 p.m. PT.
Railroad EDI Enrollment Packet