Terminologies Flashcards
What is a NPI?
National Provider Identifier): 10-digit ID for providers.
What is NPES?
Online system for healthcare providers to apply for and manage their NPIs.
(National Plan and Provider Enumeration System):
Why is NPI & NPES Important?
Providers need NPI# for billing. & NPES to help them apply and update their info.
What is Credentialing?
Verifying a provider’s qualifications (licenses, certifications)
What is Re-credentialing?
Reviewing and verifying the qualifications of a healthcare provider or a facility (every 2-3 years)
Why is Credentialing/Re-credentialing important?
It ensures that providers have the qualifications, licenses & are compliant.
What is PECOS?
it’s a online system to enroll in and manage their Medicare service credentials.
Provider Enrollment, Chain, and Ownership System):
Why PECOS is important?
PECOS is important for ensuring that only qualified and verified providers are able to bill Medicare.
(Provider Enrollment Chain and Ownership System)
What is NCPDP?
Is an organization that creates standardized protocols for electronic transactions related to pharmacy services.
(National Council for Prescription Drug Programs)
Why NCPDP important?
It ensures that prescription data and related information are transmitted clearly and consistently for pharmacy credentialing tasks.
What is Manage Care contracts?
Agreements between payors and providers outlining service terms and fee schedules.
Why Is Manage Care contracts important?
It’s important for contract renewals, fee schedules & payment terms.
What is PBM Re-credentialing?
Renewing and validating the credentials of pharmacies that are part of a (Pharmacy Benefit Manager’s)
Why is PBM Re-credentialing important?
It’s crucial because it ensures that** pharmacies** within a (PBM) network continue to meet required standards for safety, quality, and compliance.
