Provider Enrollment Terms You Should Know

When it comes to medical credentialing and provider enrollment the myriad terms and acronyms used make a complex process even more complicated. If you don’t know you’re NPP from your NPI, 1st Assistant is here to help. Below is a glossary of commonly used abbreviations and acronyms that you can use as a “cheat sheet” and quick reference guide.

• CAQH – Council for Affordable Quality Healthcare – a nonprofit alliance of networks, health plans and trade associations that acts as a catalyst for initiatives that simplify healthcare administration.

• CMS – The Centers for Medicare & Medicaid Services is the overseer of federal healthcare systems.

• DMEPOS – Durable Medical Equipment, Prosthetic and Orthotic Suppliers

• EFT – Electronic Funds Transfer – a system that moves money from one bank account to another electronically.

• MAC – Medicare Administrative Contractor – a private health care insurer that has been awarded a geographic jurisdiction to process Medicare or durable medical equipment claims.

• MLN – Medicare Learning Network.

• NPDB – National Practitioner Data Bank – an online repository of informational reports such as adverse actions on health care practitioners, providers and suppliers and malpractice payments.

• NPI – National Provider Identifier – a unique, intelligence-free (randomly assigned and containing no coded data) 10-digit number issued to U.S. health care providers by CMS.

• NPP – Non-Physician Practitioner – some examples are physical and occupational therapists, psychologists, audiologists and nurse midwives.

• NPPES – National Plan and Provider Enumeration System – CMS system that assigns NPI numbers.

• NSC – National Supplier Clearinghouse — responsible for issuing or revoking Medicare supplier billing privileges for DMEPOS suppliers.

• PECOS – Provider Enrollment and Chain/Ownership System – the electronic portal through which health care providers enroll in Medicare.

• PTAN – Provider Transaction Access Number – a Medicare-only provider number issued by MACs when providers are enrolled with Medicare.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.