The Pennsylvania Medicheck Precluded Providers List

What is the Pennsylvania Medicheck List?

The Medicheck List names individuals and providers who are precluded from Medical Assistance (MA) Program participation. When a provider’s name is added to the list, their enrollment and participation in the MA program is terminated, and that provider may also be subject to fines and the reimbursement of overpayments.

Medicheck preclusions follow criminal, disciplinary, or professional actions that have been taken against the provider. These can include failure to comply with agreements, termination from Medicaid, criminal convictions, fraud, OIG exclusions, licensing issues, and more.

Why do MA providers need to use the Medicheck List?

MA Providers should use the Medicheck list to ensure individuals precluded from MA participation are not authorizing services or prescriptions. When you check providers against the list, you protect both patients and your practice. If you submit a claim for a service or prescription ordered by a precluded individual, the Department of Human Services will not pay the claim, nor will it reimburse you. To maintain compliance, you should check any provider, employee, or contractor at the beginning of the contract and on an ongoing monthly basis.

The Medicheck list is updated daily on the Medicheck site. When you visit the site, you may search by provider last name, business name, and license number. Once the listing appears on your screen, verify the listing by emailing the name, date of birth, last four digits of the Social Security Number, and license number (if applicable) to RA-BPI-Preclusions@pa.gov. Responses can take up to ten days.

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Can a precluded provider be reinstated?

If a precluded provider wishes to be reinstated in the Medical Assistance program, they must wait to apply until the end of their preclusion period. The Department of Human Services will then determine whether or not to reinstate the provider.

Other exclusion databases to check along with the Medicheck List

In addition to the Medicheck List, providers should also check federal databases, particularly LEIE (maintained by the Office of Inspector General), SAM, FDA, DEA, and other exclusion lists. Although state databases also contain federally excluded individuals, it’s best practice to check state and federal databases in order to verify providers against the most current information.

FACIS^® by Verisys makes it easy to verify provider credentials not only against State Exclusion databases but also against all federal exclusion data sources. Learn more from Verisys about how you can ensure your providers’ credentials meet all government and regulatory standards.

Learn more about how Verisys can assist your HCOs in meeting all government and regulatory standards.
 

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