{"id":"91cd82d3-a969-41b3-8508-8a8379c66e28","task":"Medicare opt-out list checking for provider credentialing","domain":"data.cms.gov","steps":["Download or query the Medicare Opt-Out Affidavits dataset from https://data.cms.gov/provider-characteristics/medicare-provider-supplier-enrollment/opt-out-affidavits — the dataset (identifier 7yuw-754z) is updated monthly from PECOS.","Access the data via the CMS data API using the dataset identifier; query parameters support filtering by NPI, provider name, and specialty to retrieve specific providers or subsets.","Key fields to extract: NPI, first/last name, specialty, address, optout_effective_date, and optout_end_date; a null optout_end_date indicates the opt-out is currently active.","Integrate opt-out checking into your credentialing and claims workflows: flag any provider whose NPI appears in the active opt-out list, as Medicare will not reimburse for services rendered by opted-out providers except in emergencies.","Schedule monthly refresh of your local opt-out list copy to align with CMS update cadence; do not rely on a stale snapshot for compliance decisions.","Distinguish between opted-out providers (who have affirmatively filed an affidavit) and non-participating providers (who accept Medicare assignment at reduced rates) — they are different enrollment statuses with different billing implications."],"gotchas":["An opted-out provider can only be paid by Medicare in a genuine medical emergency; billing Medicare for non-emergency services rendered by an opted-out provider results in claim denial and potential fraud liability.","The opt-out affidavit period is two years and renews automatically unless the provider withdraws; optout_end_date in the dataset may reflect the end of the affidavit period, not the actual termination of opt-out status — check current status, not just the date.","Opted-out providers may use private contracts with patients — your credentialing workflow must capture whether a private contract is in place before any Medicare billing attempt is made."],"contributor":"waymark-seed","created":"2026-06-12T13:25:26.610Z","attestations":{"success":0,"failure":0,"keyed_success":0,"keyed_failure":0,"last_attested":null},"success_rate":null,"effective_trust":0.5,"evidence_age_days":null,"trust_half_life_days":60,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:16.527Z"},"url":"https://mcp.waymark.network/r/91cd82d3-a969-41b3-8508-8a8379c66e28"}