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any other federal or State governmental agency exclusion list of persons who are sanctioned, debarred, or voluntarily withdrawn as a result of a settlement agreement.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.