Preferred Provider List Additions Sample Clauses

Preferred Provider List Additions. The ACO shall not add an individual or entity to the Preferred Provider List during the Performance Year without prior written approval from CMS. If the ACO wishes to add an individual or entity to the Preferred Provider List during the Performance Year, it shall submit a request to CMS in the form and manner and by a deadline specified by CMS. CMS may accept requests for additions to the Preferred Provider List during the Performance Year only under the following circumstances: i. The request for addition is submitted to CMS between January 1 and September 30 of the Performance Year; ii. The ACO certifies that is has a fully executed written agreement with the individual or entity it wishes to add to the Preferred Provider List and that the agreement meets the requirements of Section III.D.6; and iii. The ACO certifies that it has furnished a written notice to the executive of the TIN through which such individual bills Medicare indicating that the ACO has proposed to add the individual to the ACO’s Preferred Provider List. The notice to the TIN must identify by name and NPI each individual who is identified on the request for addition as billing through the TIN. The ACO must also certify that it has furnished a written notice to the executive of each entity that it wishes to add to its Preferred Provider List. CMS may reject the request on the basis that the individual or entity fails to satisfy the requirements of paragraph (A) or paragraphs (C) through (F) of the definition of “Preferred Provider,” or on the basis of information obtained from a program integrity screening. If CMS approves the request, the individual or entity will be added to the Preferred Provider List effective on the date the addition is approved by CMS.
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Preferred Provider List Additions. The ACO shall not add an individual or entity to the Preferred Provider List during a Performance Year without prior written approval from CMS. If the ACO wishes to add an individual or entity to the Preferred Provider List during a Performance Year, it shall submit a request to CMS in the form and manner and by a deadline specified by CMS, under the following requirements: i. The ACO certifies that is has a fully executed written agreement with the individual or entity it wishes to add to the Preferred Provider List and that the agreement meets the requirements of Section III.D.6; and ii. The ACO certifies that it has furnished a written notice to the executive of each entity identified in the request for addition through whose TIN a Preferred Provider bills Medicare. The notice must identify by name and NPI each individual who is identified on the request for addition as billing through the entity’s TIN. CMS may reject the request on the basis that the individual or entity fails to satisfy the definition of “Preferred Provider,” or on the basis of information obtained from a program integrity screening. If CMS approves the request, the individual or entity will be added to the Preferred Provider List effective on the date the addition is approved by CMS.
Sample 1

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