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National Provider Identifier (NPI)

A unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

Federal health care program

Any plan or program that provides health benefits, whether directly or through insurance, which is funded directly or indirectly by the U.S. government, such as Medicare, Medicaid, and TRICARE.

Medicare Advantage plan

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.

Excluded entity

An individual or organization that has been banned by the government from participating in federal health care programs, often due to fraud, abuse, or other violations.

Encounter data

Information submitted by health plans, like Medicare Advantage plans, about the services their members receive. This data helps the government understand care patterns and costs.

Telehealth company

An entity that primarily employs or contracts with doctors or practitioners to provide health services remotely (telehealth), rather than in person.

Claims modifier