Skip to main content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Recommendation Followup: Ensuring that MAOs Submit Rendering Provider Identifiers for Applicable Encounter Records

A rendering provider National Provider Identifier (NPI) is a critical data element on Medicare Advantage (MA) encounter records that: (1) identifies the individual who performed a health care service and (2) enables oversight entities and MA organizations (MAOs) to identify individuals who may pose a risk to Federal funds and enrollee safety. CMS stated that it requires MAOs to submit the rendering provider NPI when it differs from the billing provider NPI. A 2018 OIG report found that rendering provider NPIs were missing on 13 percent of 2014 MA encounter records for outpatient evaluation and management services in which the billing provider was an organization (e.g., a clinic or a provider group). We continue to be concerned that the omission of rendering provider NPIs may impede oversight and program integrity activities. This new evaluation will review 2024 encounter data to determine whether MAOs are submitting rendering provider NPIs.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2025 CMS Recommendation Followup: Ensuring that MAOs Submit Rendering Provider Identifiers for Applicable Encounter Records Office of Evaluation and Investigations OEI-03-25-00440 2027