NPI Monitoring Made Simple

ProviderTrust automates ongoing NPI validation, exclusions monitoring, as well as license and sanctions verification for provider networks and health plans.

NPI monitoring shouldn’t be complex.

Simplify ongoing monitoring of your entire provider network across all federal and state exclusions lists, state licensing boards, Medicare Opt Out, OFAC, CMS Preclusion List, NPI Registry from NPPES, and more with ProviderTrust.

  • Validate NPI numbers against NPPES NPI Registry
  • Automate ongoing exclusions monitoring across all federal and state primary sources
  • Screen your provider network against the CMS Preclusion List
  • Verify and store licenses, credentials, and certifications for your providers
    Complete provider directory profiles with primary source data

Need help with monitoring your providers? Connect with ProviderTrust to learn more about how we can help.

NPI Frequently Asked Questions

NPPES is a database administered by the Centers for Medicare and Medicaid Services (CMS) to improve the efficiency and effectiveness of the electronic transmission of health information by standardizing the format of unique identification for healthcare providers and health plans.

According to the Centers for Medicare and Medicaid Services (CMS), there are two types of healthcare providers in terms of NPI – Type 1 and Type 2.

Type 1 NPI Providers: Healthcare providers who are individuals, including physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI.

Type 2 NPI Providers: Healthcare providers who are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself.

A Federal Exclusion is an administrative action taken against an individual or entity (such as a provider or vendor) by the Dept. of Health and Human Services (HHS), Office of Inspector General (OIG). The HHS OIG is in charge of enforcing exclusions against individuals or entities.

Individual states maintain a Medicaid Exclusion or Terminated list as well as federal. Employers need to search these in addition to the OIG LEIE and the SAM.gov. Today, there are 42 states that have a state Medicaid exclusion list.

Physicians and practitioners who do not wish to enroll in the Medicare program may “opt-out” of Medicare. This means that neither the physician/practitioner nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician/practitioner out-of-pocket and neither party is reimbursed by Medicare.

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.

It’s time to simplify healthcare compliance.

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