Medical Review on Therapy Provider Phase Information Claims

$179 / year

The Therapy Provider Phase Information dataset is a tool for providers to search for their National Provider Identifier (NPI) number to determine their phase for manual medical review of therapy claims.

Complexity

The Centers for Medicare and Medicaid Services (CMS) has posted a list on its website assigning providers to 1 of 3 phases for manual medical review when outpatient therapy services exceed $3,700. The list identifies phase I and phase II providers by their National Provider Identifier; those who do not appear on the list are included in phase III. The phases delineate the time frames during which the providers would be required to obtain advanced approval from their Medicare Administrative Contractor (MAC) in order to receive coverage for outpatient therapy services beyond $3,700.
Phase 1 providers will be subject to the manual medical review process from October 1 – December 31, 2012
Phase 2 providers will be subject to the manual medical review process from November 1 – December 31, 2012
Phase 3 providers will be subject to the manual medical review process from December 1 – December 31, 2012

Date Created

2012-08-22

Last Modified

2017-12-12

Version

2017-12-12

Update Frequency

Irregular

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

National Provider Identifier, Therapy Providers, Therapy Provider Information, Therapy Provider NPI, Medical Therapy, Therapy Phase, CMS Physical Therapy

Other Titles

Medical Review Services, Therapy Provider Phase Information

NameDescriptionTypeConstraints
National_Provider_IdentifierA National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).integerlevel : Nominal required : 1
Therapy_PhaseTherapy phase ranging from 1 to 3.integerlevel : Nominal required : 1
National Provider IdentifierTherapy Phase
10030003811
10030006051
10030006471
10030012491
10030025021
10030030211
10030030882
10030031611
10030037652
10030052082