Preclusion List definition

Preclusion List means the CMS-compiled 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.
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Preclusion List. The list maintained by CMS under42 C.F.R. § 422.222 and defined in 42 C.F.R. § 422.2.
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Preclusion List means the CMS Preclusion List and/or the OIG exclusion list.
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Examples of Preclusion List in a sentence

  • Thus, a plan may provide a beneficiary with more than 60 days’ notice, and if a plan does so, the plan should not deny payments/reject claims earlier than 90 days after publication of the associated Preclusion List.

  • Currently the Preclusion List will not be made available publically because it contains Medicare revocation data.

  • Plans can refer to the updated Preclusion List file layout and sample file located at https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/MedicareProviderSupEnroll/PreclusionList.html.

  • Databases include the CMS Preclusion List, the OIG List of Excluded Individuals/Entities (“LEIE”), the System for Award Management (“SAM”) exclusion lists, and any other federal or State governmental agency exclusion list of persons who are sanctioned, debarred, or voluntarily withdrawn as a result of a settlement agreement.

  • Therefore, Part D plans should not reject claims if the prescribing or dispensing pharmacy is included on the Preclusion List and has not yet been removed from the plan’s network.

  • As stated in the November 2, 2018 HPMS guidance memo, “CMS recommends that Medicare plans and Part D plans follow the same process for monthly updates to the Preclusion List as they did for the initial list.

  • For instructions on how to access the Preclusion List visit https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/MedicareProviderSupEnroll/PreclusionList.html.

  • This Agreement shall terminate immediately if the Vendor is suspended from participating in or becomes listed on a debarment or exclusion list relating to state or federal health care programs (including, without limitation, the List of Excluded Individuals and Entities, the Medi-Cal Suspended and Ineligible Provider List, System for Award Management, or CMS Preclusion List).

  • Part C plans should deny payment if the pharmacy is included on the Preclusion List.

  • Members will be notified within 30 days of the Health Plan receiving the Preclusion List.


More Definitions of Preclusion List

Preclusion List shall be added to the Contract as follows:
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Preclusion List means the CMS-compiled 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 by Medicare beneficiaries.” 4. The following paragraph shall be added to the end of Section 3.13 “CalOptima QMI Program”: “County shall allow CalOptima to use performance data for CalOptima’s quality improvement program activities and mandatory performance data reporting to CalOptima’s Regulators.”
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Preclusion List means the CMS-compiled list of individuals and entities that -
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Related to Preclusion List

  • Exclusion List means the HHS/OIG List of Excluded Individuals/Entities (LEIE) (available through the Internet at xxxx://xxx.xxx.xxx.xxx).

  • DQ List has the meaning assigned to such term in Section 9.04(e)(iv).

  • Update means a hotfix, patch or minor version update to any Platform software; and

  • Statement of Grievance shall name the grievant(s) involved, the facts giving rise to the grievance, the provision(s) of the Agreement alleged to be violated, and the remedy (specific relief) requested.

  • Seismic impact zone means an area with a 10% or greater probability that the maximum horizontal acceleration in lithified earth material, expressed as a percentage of the earth's gravitational pull (g), will exceed 0.10g in 250 years.

  • Material safety data sheet or "MSDS" means the chemical, physical, technical, and safety information document supplied by the manufacturer of the coating, solvent, or other chemical product, usually through the distribution network or retailers.

  • acid attack victims means a person disfigured due to violent assaults by throwing of acid or similar corrosive substance.

  • System Impact Study means an assessment by the Transmission Provider of (i) the adequacy of the Transmission System to accommodate a Completed Application, an Interconnection Request or an Upgrade Request, (ii) whether any additional costs may be incurred in order to provide such transmission service or to accommodate an Interconnection Request, and (iii) with respect to an Interconnection Request, an estimated date that an Interconnection Customer’s Customer Facility can be interconnected with the Transmission System and an estimate of the Interconnection Customer’s cost responsibility for the interconnection; and (iv) with respect to an Upgrade Request, the estimated cost of the requested system upgrades or expansion, or of the cost of the system upgrades or expansion, necessary to provide the requested incremental rights. “System Protection Facilities” shall refer to the equipment required to protect (i) the Transmission System, other delivery systems and/or other generating systems connected to the Transmission System from faults or other electrical disturbance occurring at or on the Customer Facility, and (ii) the Customer Facility from faults or other electrical system disturbance occurring on the Transmission System or on other delivery systems and/or other generating systems to which the Transmission System is directly or indirectly connected. System Protection Facilities shall include such protective and regulating devices as are identified in the Applicable Technical Requirements and Standards or that are required by Applicable Laws and Regulations or other Applicable Standards, or as are otherwise necessary to protect personnel and equipment and to minimize deleterious effects to the Transmission System arising from the Customer Facility.

  • Feasibility Report means a detailed report, in form and substance sufficient for presentation to arm's length institutional lenders considering project financing, showing the feasibility of placing any part of the Property into commercial production as a Mine and shall include a reasonable assessment of the various categories of ore reserves and their amenability to metallurgical treatment, a complete description of the work, equipment and supplies required to bring such part of the Property into commercial production and the estimated cost thereof, a description of the mining methods to be employed and a financial appraisal of the proposed operations and including at least the following: (i) a description of that part of the Property to be covered by the proposed Mine; (ii) the estimated recoverable reserves of Minerals and the estimated composition and content thereof; (iii) the proposed procedure for development, mining and production; (iv) results of ore amenability treatment tests (if any); (v) the nature and extent of the facilities proposed to be acquired, which may include mill facilities if the size, extent and location of the ore body makes such mill facilities feasible, in which event the study shall also include a preliminary design for such mill; (vi) the total costs, including capital budget, which are reasonably required to purchase, construct and install all structures, machinery and equipment required for the proposed Mine, including a schedule of timing of such requirements; (vii) all environmental impact studies and costs of implementation; (viii) the period in which it is proposed the Property shall be brought to commercial production; and (ix) such other data and information as are reasonably necessary to substantiate the existence of an ore deposit of sufficient size and grade to justify development of a mine, taking into account all relevant business, tax and other economic considerations including a cost comparison between purchasing or leasing and renting of facilities and equipment required for the operation of the Property as a Mine.

  • Finalist means an Offeror who meets all the mandatory specifications of this Request for Proposals and whose score on evaluation factors is sufficiently high to merit further consideration by the Evaluation Committee.

  • Imminent safety hazard means an imminent and unreasonable risk of death or severe personal injury.

  • Debarment means an action taken by a Federal agency or official to exclude a person or business entity from participating in transactions involving certain federal funds.

  • Extended producer responsibility ’ (EPR) means responsibility of any producer of packaging products such as plastic, tin, glass, wrappers and corrugated boxes, etc., for environmentally sound management, till end-of-life of the packaging products ;

  • Mechanical restraint means any device or object used to limit a student’s movement.

  • Contractor/Supplier means the person or company whose tender is accepted by the Purchaser and shall be deemed to include the Contractor’s successors, heirs, executors, administrators, representatives and assigns approved by the Purchaser.

  • Adhesion promoter means a very thin coating applied to a substrate to promote wetting and form a chemical bond with the subsequently applied material.

  • Sustainability Report the annual non-financial disclosure report prepared in accordance with the Standard for Sustainability Reporting publicly reported by the Borrowers and published on an Internet or intranet website to which each Bank and the Administrative Agent have been granted access free of charge (or at the expense of the Borrowers).

  • Safety Data Sheet means a safety data sheet within the meaning of regulation 5 of the CHIP Regulations;

  • Submission Location means the submission location identified as such in the Summary of Key Information.

  • Amended Complaint means the Consolidated Amended Class Action Complaint, dated February 12, 2015, filed in this Action.

  • Material Compliance Matter has the same meaning as the term defined in Rule 38a-1, and includes any compliance matter that involves: (1) a violation of the federal securities laws by Distributor (or its officers, directors, employees, or agents); (2) a violation of Distributor's Rule 38a-1 policies and procedures; or (3) a weakness in the design or implementation of Distributor's Rule 38a-1 policies and procedures.

  • Public Procurement Regulatory Authority (PPRA) means the Government Agency responsible for oversight of public procurement.

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Mechanical Treatment means the use of power saws, axes, or other approved tools to remove trees.

  • Urgent medical condition means a condition that satisfies either of the following:

  • Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.