What is the Preclusion List?
A list of providers and prescribers who are precluded from receiving payment for Medicare Advantage (MA) items and services or Part D drugs furnished or prescribed to Medicare beneficiaries.
Why was the list created?
- To replace the Medicare Advantage (MA) and prescriber enrollment requirements.
- To ensure patient protections and safety and to protect the Trust Funds from prescribers and providers identified as bad actors.
Who is on the list?
Individuals or entities who meet the following criteria:
What happens if I'm on the Preclusion List?
You will receive an email and letter from CMS/Medicare Administrative Contractors (MAC) in advance of your inclusion on the Preclusion List.
The email and letter will be sent to your Provider Enrollment Chain and Ownership System (PECOS) address or National Plan and Provider Enumeration System (NPPES) mailing
The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal.
What's the impact?
CMS made the Preclusion List available to Part D sponsors and the MA plans on January 1, 2019. EFFECTIVE AS OF APRIL 1, 2019:
- Part D sponsors are required to reject a pharmacy claim (or deny a beneficiary request for reimbursement) for a Part D drug that is prescribed by an individual on the Preclusion List.
- MA plans are required to deny payment for a health care item or service furnished by an individual or entity on the Preclusion List.
Want to learn more?
Need more information?
Please contact email@example.com