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

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any other federal or State governmental agency exclusion list of persons who are sanctioned, debarred, or voluntarily withdrawn as a result of a settlement agreement.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 means the CMS-compiled list of individuals and entities that -
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.”
Preclusion List shall be added to the Contract as follows:

Related to Preclusion List

  • 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.

  • 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.

  • 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.