AHCCCS completes routine electronic checks for providers, any person with an ownership or controlling interest in the provider, an agent, or a managing employee. The electronic checks are to verify if the parties:
Have been excluded from Medicare, Medicaid, or from receiving federal contracts,
Do not have new sanctions or other actions against their license, or
Do not have criminal history which needs to be reviewed by AHCCCS.
The table below describes the different systems used for the routine checks.
|
System |
Frequency |
|
Social Security Administration's Death Master File |
At initial enrollment, and monthly after enrollment |
|
National Plan and Provider Enumeration System (NPPES)
|
|
|
List of Excluded Individuals/Entities (LEIE) |
|
|
Medicare Exclusion Database (MED) |
|
|
Excluded Parties List System (EPLS) |
|
|
System for Award Management (SAM) |
|
|
Database Exchange (DEX) |
|
|
Arizona Department of Health Services (AZDHS) |
|
|
Arizona Board of Medical Examiners |
|
|
Any other such databases that CMS or the State may prescribe through regulations or guidance to confirm identity |
Initial enrollment, revalidation, and reoccurring cadence as designated by CMS guidance or state or federal regulations |
AHCCCS will deny or terminate providers if any of the persons searched are found in the LEIE, MED, SAM, EPLS, DEX, or any other database that CMS prescribes through regulations or in guidance.
Proof is collected from federal, state, and other publicly available databases.
42 CFR 455.436
45 CFR 160.103