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Medicare Advantage

Medicare Advantage Preclusion List Update

January 1, 2020

The Centers for Medicare and Medicaid Services (CMS) created a Medicare Preclusion list for providers who are unable to be paid for services provided to Medicare beneficiaries, including those who receive services through a Medicare Advantage Plan. A recent update to the Preclusion list rule requires providers to understand the following:

  • If a provider is placed on the Preclusion list, he/she is no longer eligible for payment from Northeast Delta Dental for services provided to Medicare Advantage beneficiaries;
  • The provider is prohibited from pursing payment from the beneficiary for services rendered while on the Preclusion list; and
  • The provider is financially liable for any services provided while on the Preclusion list.

These provisions go into effect after the provider has exhausted his/her 60-day appeal period with CMS. CMS is responsible for notifying providers of being placed on the Preclusion list.