Ptan Request For Railroad Medicare PDF Details

Railroad Medicare can be a great option for retirees who worked in the railroad industry. However, in order to qualify for Railroad Medicare, you must first complete and submit a Ptan Request For Railroad Medicare Form. The form is available on the Railroad Retirement Board's website, and it's important to ensure that all information is accurate and complete before submitting. Failure to do so may lead to delays or even denied benefits. So if you're considering Railroad Medicare, be sure to download and fill out the Ptan Request For Railroad Medicare Form today.

You can find more info concerning the ptan request for railroad medicare by checking out the table our team put together.

Form NamePtan Request For Railroad Medicare
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesptan, ptan application, medicare, railroad

Form Preview Example

PO BOX 10066 | Augusta, Georgia 30999-0001 | | ISO 9001


Request for Railroad Medicare PTAN for Electronic Submitters

This form is for electronic claim submitters only.

§Please enter your information into this form prior to pressing the PRINT button. Any forms printed blank and then handwritten will cause processing delays.

§Provider(s) must have provided a service(s) to a Railroad Medicare beneficiary.

§Provider(s) must already be enrolled with your local Medicare Administrative Contractor (MAC).

§To enroll with EDI visit,

§This form may be completed for up to 5 providers, for more than 5 providers complete additional forms.

§Please do not submit changes to your existing Railroad Medicare PTANs on this form.


Legal Business Name:

Tax Identification Number:

Payment/Remit Address:


Practice Location Address: City:



Zip Code:


Zip Code:

Individual NPI


Last Name

First Name

Group NPI #

Local MAC Group


Submitter Name: Phone Number:

Please Fax This Form to (803) 382-2417


A RRB-Contracted Specialty Medicare Administrative Contractor

How to Edit Ptan Request For Railroad Medicare Online for Free

Having the purpose of allowing it to be as quick to use as it can be, we built the PDF editor. The process of filling out the railroad will be quick for those who keep to the next actions.

Step 1: Hit the "Get Form Now" button to begin the process.

Step 2: You are now allowed to change railroad. You have many options thanks to our multifunctional toolbar - you'll be able to add, erase, or modify the content material, highlight the selected components, and carry out other commands.

To get the document, provide the content the software will request you to for each of the following parts:

medicare ptan application empty spaces to fill out

In the area City, Practice Location Address, City, State, Zip Code, State, Zip Code, Individual NPI, Local MAC PTAN, Last Name, First Name, Group NPI, Local MAC Group PTAN, Submitter Name, and Phone Number write down the information that the platform demands you to do.

step 2 to completing medicare ptan application

Step 3: Click the "Done" button. You can now transfer your PDF form to your device. As well as that, you may forward it by means of electronic mail.

Step 4: In order to avoid any sort of troubles as time goes on, you should make at the very least a couple of copies of your document.

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