Preclusion List
CMS list of prescribers and providers whose claims and prescriptions are denied payment by Medicare Advantage and Part D.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Enrollment
- Primary sources
- 1
- Workspace handoff
- compliance binder →
Where this comes up
Credentialing and revenue-cycle staff handle this — CAQH ProView upkeep, payer-roster validation, NPI maintenance, PECOS revalidation cycles, and the gap between application and effective date that strands new providers. Lapses here block payment until backdated re-enrollment closes the gap.
Full definition
What it is in practice
CMS publishes the Preclusion List. Inclusion follows revocation or comparable conduct; appeal rights apply.
How it shows up in your practice
Screen prescribers against the Preclusion List monthly. Excluded providers' prescriptions are denied at the Part D point of sale.
Sources
- CMS — Provider Enrollment Revalidationhttps://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/revalidation
Run preclusion screening in the Compliance Binder
Open compliance binder →Related terms
- EnrollmentRevocationTermination of a provider's Medicare enrollment for grounds enumerated at 42 CFR 424.535, including non-compliance, felony convictions, false information, abuse of billing privileges.
- EnrollmentLEIE Exclusion ScreeningMonthly screening of staff and vendors against the HHS-OIG List of Excluded Individuals/Entities (LEIE).
- EnrollmentDeactivationRemoval of a provider from Medicare's enrollment file, typically for failing to revalidate, billing inactivity, or final adverse action.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryDeactivationRemoval of a provider from Medicare's enrollment file, typically for failing to revalidate, billing inactivity, or final adverse action.
- GlossaryLEIE Exclusion ScreeningMonthly screening of staff and vendors against the HHS-OIG List of Excluded Individuals/Entities (LEIE).
- GlossaryRevocationTermination of a provider's Medicare enrollment for grounds enumerated at 42 CFR 424.535, including non-compliance, felony convictions, false information, abuse of billing privileges.
- GlossaryProvider Enrollment RevalidationCMS requirement to periodically re-submit and validate enrollment information to remain Medicare-enrolled.
- RegulationCMS-855A: Medicare Enrollment for Institutional ProvidersMedicare enrollment application for institutional providers including hospitals, CAHs, hospices, home health agencies, federally qualified health centers, rural health clinics, and similar entities.
- RegulationCMS-855B: Medicare Enrollment Application for Clinics and Group PracticesThe Medicare enrollment application for clinics, group practices, and certain other suppliers — the primary enrollment vehicle for medical practices that bill Part B.
- RegulationCMS-855I: Medicare Enrollment Application for Individual Physicians and Non-Physician PractitionersIndividual Medicare enrollment vehicle for physicians, NPPs, and certain other individual suppliers; required for any clinician billing Medicare under their own name.
- RegulationCMS-855O: Medicare Enrollment for Eligible Ordering and Certifying Physicians and Other Eligible ProfessionalsAbbreviated Medicare enrollment for clinicians who order or certify items and services for Medicare beneficiaries but do not personally bill Medicare.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.