CMS Preclusions Screening

Summary

This article explains how CMS Preclusions monitoring works in PT App, including how clients securely provide the monthly CMS Preclusion List, what subject data is required for screening, how ProviderTrust validates and screens those subjects, and the types of results clients receive. It also outlines the responsibilities of both clients and ProviderTrust to ensure accurate, consistent monitoring and clear communication around CMS Preclusion List compliance.

Responsibilities: ProviderTrust vs. Client 

Client Responsibilities

Clients are responsible for:

• Obtaining the CMS Preclusion List directly from CMS.

• Uploading the list via the secure ShareFile link at the start of each month.

• Providing complete and accurate identifying information for each subject.

• Reviewing returned results in PT App and taking appropriate internal action for any matches.

ProviderTrust Responsibilities

ProviderTrust is responsible for:

• Validating uploaded Preclusion List files for accuracy and completeness.

• Loading CMS Preclusion file into our secure database each month.

• Screening People and Organizations against the Preclusion List.

• Returning consistent, clearly labeled results (Match, No Match, or Insufficient Data).

• Ensuring monitoring is performed securely and reliably within PT App.

What Clients Can Expect

Clients contracted for CMS Preclusions monitoring through PT App can expect:

• Monthly automated screening of all submitted subjects.

• Clear, color-coded results visible in the PT App Dashboard.

• Reliable data validation and processing performed by ProviderTrust.

• Predictable and consistent screening criteria, using a single validated Preclusion List for all clients.

1. Secure List Submission (Client Responsibility)

Since CMS does not make the Preclusion List public, each contracted client must supply their copy of the list directly to ProviderTrust.

Each month:

1. Client Care provides a ShareFile link designated for secure transfer.

2. Clients upload their copy of the CMS Preclusion List via this link.

3. ProviderTrust receives, verifies, and prepares the file for screening.

2. Client Data Provided for Screening

PT App screens the following subject types:

People

Clients must provide at a minimum:

• First Name

• Last Name

• NPI

Organizations

Clients may provide:

• Organization Name, and

• One or both of the following:

  • EIN

  • NPI

Providing both identifiers (EIN + NPI) increases match accuracy.

3. Screening Performed by ProviderTrust

ProviderTrust conducts monthly screening by comparing client subjects (People and Organizations) against the validated CMS Preclusion List file.

We return one of the standardized result types below.

Returned Results & What They Mean

People (Individuals)

Organizations