Preclusion List

Preclusion List
Important changes to the
CMS Enterprise Identity Management System

The CMS Enterprise Identity Management System (EIDM), which manages the access to the Preclusion List application and the monthly files, will be replaced with CMS Identity Management System (IDM). This change is planned to occur February 19, 2021 with the first date end users will encounter IDM as Monday, February 22. 2021. During the maintenance window, access to the Preclusion List application and the files may not be available. Additionally, please do not add or remove any roles prior to the Go Live date of Monday, February 22, 2021.

For more details, please read the Preclusion List EIDM to IDM Migration Help Guide (PDF).

icon of question mark
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.

icon of question mark
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.
icon of question mark
Who is on the list?
Individuals or entities who meet the following criteria:

Are currently revoked from Medicare, are under an active reenrollment bar, and CMS has determined that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program.

OR

Have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare Program.

OR

Have been convicted of a felony under federal or state law within the previous 10 years that CMS deems detrimental to the best interests of the Medicare program.

What happens if I'm on the Preclusion List?
icon of envelope

You will receive an email and letter from CMS/Medicare Administrative Contractors (MAC) in advance of your inclusion on the Preclusion List.

icon of envelope

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 address.

icon of documents

The letter will contain the reason you are precluded, the effective date of your preclusion, and your applicable rights to appeal.

icon of question mark
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:

icon of calendar
  • 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.
icon of question mark
Need more information?

Please contact providerenrollment@cms.hhs.gov.

Page Last Modified:
02/22/2021 11:54 AM