ABC’s – A Provider Enrollment Glossary

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CAQH, CMS, NPI … the world of medical credentialing and provider enrollment is full of acronyms. These can be difficult to keep straight, especially if you don’t deal with them every day.

To help you navigate this acronym-crowded world, we’ve created a list of common acronyms and their meanings. Let us know if we have omitted your favorite – or the one that you can never remember – by replying to this blog! 

Provider Enrollment ABC’s

  • CAQH– Council for Affordable Quality Healthcare – a nonprofit alliance of health plans, networks and trade associations that acts as a catalyst for initiatives that simplify healthcare administration. 
  • CMS– The Centers for Medicare & Medicaid Services oversees federal healthcare systems.
  • DMEPOS – Durable Medical Equipment, Prosthetic and Orthotic Suppliers.
  • EFT – Electronic Funds Transfer – a system that transfers money from one bank account to another without paper money changing hands.
  • MAC– Medicare Administrative Contractor – a private health care insurer that has been awarded a geographic jurisdiction to process Medicare claims or durable medical equipment claims.
  • MLN– Medicare Learning Network.
  • NPDB– National Practitioner Data Bank – a web-based repository of informational reports such as malpractice payments and adverse actions on health care practitioners, providers and suppliers. 
  • NPI– National Provider Identifier – a unique, 10-digit number issued to U.S. health care providers by CMS. 
  • NPP – Non-Physician Practitioner – examples are nurse practitioners and physician assistants.
  • NPPES– National Plan and Provider Enumeration system – CMS system that assigns NPI numbers.
  • NSC– National Supplier Clearinghouse is responsible for issuing or revoking Medicare supplier billing privileges for DMEPOS suppliers.
  • PECOS– Provider Enrollment and Chain/Ownership System – the electronic portal through which health care providers enroll in Medicare.
  • PTAN– Provider Transaction Access Number – a Medicare-only provider number issued by MACs when providers are enrolled with Medicare. 

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.