Others titles

  • Public Provider Enrollment Extract Reassignment Sub File
  • Public Provider Reassigning Benefits Data
  • Public Provider Reassigned Benefits Data

Keywords

  • Medicare Public Provider Enrollment Data
  • Medicare Public Provider Reassignment Data
  • Medicare Public Provider Reassignment Sub File
  • Medicare Public Provider
  • Medicare Enrollment Data
  • Medicare Providers
  • Reassignment Benefits
  • Enrollment Extract
  • PECOS Assigned ID
  • PECOS Associate Control ID (PAC ID)

Medicare Public Provider Enrollment Data Reassignment Sub File 2016 Q2

The Public Provider Enrollment data for Medicare fee-for-service includes providers who are actively approved to bill Medicare. This dataset contains an enrollment ID crosswalk between those individual providers reassigning their benefits and those providers receiving the reassignment of benefits.

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Description

The source of this data is the Provider Enrollment, Chain and Ownership System, or PECOS (pronounced pey-kohs). PECOS is the national data repository for individual and organizational providers who have enrolled or are enrolling in Medicare. Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractors (MACs) enroll providers using PECOS. As part of the enrollment process, the MACs collect information related to the provider’s identity, specialty, qualifications, practice locations, ownership, billing agency information, reassignment of benefits, and related organizations etc. information on providers who have opted out of Medicare.

This dataset is populated from Provider Enrollment, Chain and Ownership System (PECOS) and contain basic enrollment and provider information (Enrollment), reassignment of benefits information (Reassignment) and practice location city, state and zip (Practice Location). This dataset is not intended to be used as real-time reporting as the data changes from day to day and the files are updated only on a quarterly basis. This data does not include information on opt-out providers. Information is redacted where necessary to protect Medicare provider privacy.

The Public Provider Enrollment Extract (PPEE) includes all provider enrollments that were approved to bill or order and refer. It includes enrollments for Individual practitioners, Both physicians, and non-physicians, Durable Medical Equipment (DME) suppliers, Part A providers, such as hospitals, hospices, and home health agencies, Part B suppliers, such as clinics/group practices and ambulance providers and Practitioners who only enroll to order and refer. The PPEE does not currently include information on providers who have opted out of Medicare.

Individual practitioners can allow other entities to bill Medicare on their behalf. This arrangement, referred to as reassignment of benefits, is stored in PECOS and can be found in the PPEE. To identify the entities that an individual reassigns their benefits to the Reassignment file is used. Instead of restricting to an individual provider National Provider Identifier (NPI) of interest, the resulting file can be subset to an enrollment ID of interest. The NPIs associated with this enrollment ID are the individuals reassigning their benefits. The practitioner enrollment ID that is reassigning benefits is given in the Reassignment_Benefit_Enrollment_ID field. The enrollment ID of the entity receiving the reassignment of benefits is given in the Received_Benefit_Enrollment_ID field.

Each enrollment in the population contains basic enrollment and provider information; reassignment of benefit information, if applicable; and practice location city, state, and zip, if applicable. This information is stored in three separate files. This is due to the one to many relationships between enrollment application information and reassignment of benefits/practice location information (e.g., a provider may have multiple practice locations).

Enrollment – This dataset contains a unique listing of all provider enrollments for an entity (Individual or Organization) that have been approved to bill or order and refer to Medicare. An entity can have one or more enrollments. The enrollment ID (ENRLMT_ID) is the unique number assigned by PECOS to identify provider enrollment applications. This dataset contains the National Provider Identifier (NPI) associated with the enrollment and the PECOS-assigned identifier, PECOS Associate Control ID or PAC ID, which is used to relate it to a TIN and uniquely identify an entity. This dataset also includes the type of provider, name, and gender.

Reassignment – This dataset contains an enrollment ID crosswalk between those individual providers reassigning their benefits and those providers receiving the reassignment of benefits. The practitioner enrollment ID that is reassigning benefits is given in the REASGN_BNFT_ENRLMT_ID field. The enrollment ID of the entity receiving the reassignment of benefits is given in the RCV_BNFT_ENRLMT_ID field. This dataset can be linked to the ENROLLMENT file using either of these enrollment ID fields.

Practice Location – This dataset contains a unique listing of practice location city, state, and zip code for each enrollment. There can be one or more locations in a single city, state and zip code combo for the same enrollment. This dataset can be linked to the ENROLLMENT file using enrollment ID.

About this Dataset

Data Info

Date Created

2016-01-26

Last Modified

2020-10-08

Version

2020-10-08

Update Frequency

Quarterly

Temporal Coverage

2020-10-21

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Public Provider Enrollment Data, Medicare Public Provider Reassignment Data, Medicare Public Provider Reassignment Sub File, Medicare Public Provider, Medicare Enrollment Data, Medicare Providers, Reassignment Benefits, Enrollment Extract, PECOS Assigned ID, PECOS Associate Control ID (PAC ID)

Other Titles

Public Provider Enrollment Extract Reassignment Sub File, Public Provider Reassigning Benefits Data, Public Provider Reassigned Benefits Data

Data Fields

Name Description Type Constraints
Enrollment_ID_of_Provider_Reassigning_BenefitsThe enrollment ID of the practitioner enrollment reassigning benefitsstring-
Enrollment_ID_of_Provider_Receiving_Reassignment_of_BenefitsThe enrollment ID of the enrollment receiving reassignment of benefitsstring-

Data Preview

Enrollment ID of Provider Reassigning BenefitsEnrollment ID of Provider Receiving Reassignment of Benefits
I20031103000001O20031216000213
I20031103000007O20040412001371
I20031103000007O20051206000046
I20031103000014O20031229000649
I20031103000020O20190812002967
I20031103000033O20040226000414
I20031103000033O20190725000986
I20031103000036O20031209000027
I20031103000037O20051216000183
I20031103000039O20040113000589