Directory · enrollment · exclusion screening
- active providers
CMS NPPES
Directory accuracy backbone
active providers (8.9M total NPI records) — NPI, taxonomy code, practice address, and entity type, distributed by CMS as a weekly full-replacement file. A plan can use the federal identifier to reconcile its own network records while retaining each source's distinct values and dates; plans must document their own No Surprises Act checks against current primary sources.
- LEIE rows
OIG LEIE + exclusion ring
Network-integrity screening
OIG HHS List of Excluded Individuals and Entities — loaded rows from the May 8, 2026 source release. The screen also consults SAM.gov, the supported state Medicaid exclusion lists currently loaded by Fonteum, OIG Corporate Integrity Agreements, and CMS Civil Money Penalties. The other states are not covered, and a no-match is not clearance.
- Active enrollment status
CMS PECOS
Medicare enrollment status
CMS PECOS Physician and Practitioner Enrollment File — Medicare enrollment indicator, provider type, and reassignment data, cross-referenced against the NPPES NPI. One of the documented federal-source catalog in the Fonteum graph, and the federal signal a Medicare Advantage plan needs to confirm a provider's active participation.
Auditable to the federal source — not a vendor's derived list
Directory accuracy CMS can trace
The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and the No Surprises Act 90-day requirement expect plans to keep directory data current against NPPES and PECOS. Fonteum makes loaded federal records accessible across active providers with source metadata where available. Fonteum's NPPES table had a newest system date of June 10, 2026 when checked July 12; that is not a source-release date or a claim that the table is current.
Exclusion screening on a monthly cadence
CMS requires Medicare Advantage and Medicaid plans to screen providers against the OIG LEIE monthly. OIG publishes monthly, but Fonteum's loaded release was dated May 8, 2026 when checked July 12. The screen also consults SAM.gov, the supported state Medicaid lists currently loaded, OIG Corporate Integrity Agreements, and CMS Civil Money Penalties; the other states are not covered. Results expose available source and observation fields, but no provenance fact currently links deterministically to a signature.
Cross-source NPI agreement, made visible
Federal files keyed to the same NPI do not always agree on address, specialty, or status. Fonteum keeps and values separate rather than silently blending them. Source and observation metadata is shown where populated; missing fields remain nullable.
From federal portal to auditable directory record
Ingest
Publisher cadence and Fonteum's loaded dates are separate. In the July 12 production audit, the newest NPPES system date was June 10, 2026; the newest PECOS source date was June 18, 2026; and the table carried a May 8, 2026 source date. The exclusion screen also consults SAM.gov and the supported state Medicaid lists currently loaded; the other states are not covered.
Provenance
Responses expose source, observation-date, and limitation fields where those values are present. Those fields are nullable and vary by dataset and endpoint; a missing value is not evidence of a completed check or a link to a signature.
Deliver
Directory and screening data is available at /research and /sanctions, through the FHIR R4 surface, via the single-NPI exclusion check at /api/v1/exclusions, and via HL7 bulk $export. Scoped pilot exports start at $2,500/mo; source and observation metadata varies by record.
Common questions
- What provider data does Fonteum give health plans for directory accuracy?
- Fonteum exposes loaded NPPES and PECOS records within a graph of the documented federal-source catalog. NPPES supplies NPI, taxonomy, address, and entity type for active providers; PECOS supplies Medicare enrollment fields where present. In the July 12 production audit, the newest NPPES system date was June 10, 2026 and the newest PECOS source-release date was June 18, 2026. Provenance fields are nullable and vary by response. Fonteum is a data layer, not a certified provider directory or network-adequacy engine.
- How does Fonteum support the No Surprises Act 90-day directory requirement?
- The No Surprises Act requires plans to re-check provider-directory information on the applicable statutory schedule. Fonteum's loaded NPPES table had a newest system date of June 10, 2026 when checked July 12; it does not by itself establish that a plan reconciled against the current federal file or satisfied a compliance deadline. Plans must document their own checks against current primary sources.
- What is cross-source NPI agreement scoring?
- A single provider can appear across several federal files — NPPES, PECOS, Care Compare, and others — and those files do not always agree on practice address, specialty, or active status. Cross-source NPI agreement compares values keyed to the same NPI without silently blending them. Where a response includes source metadata, a plan can inspect which named records concur and which diverge; missing source or observation fields remain nullable and must not be inferred.
- How does Fonteum support exclusion screening for network integrity?
- OIG publishes the LEIE monthly, but Fonteum's loaded release was dated May 8, 2026 when checked July 12. The screen also consults SAM.gov and the currently loaded state Medicaid lists for GA, IA, MD, MS, MT, NC, ND, NH, NY, OH, PA, TN, and WA; the other states are not covered. Results expose the source and observation fields available on the response. Confirm consequential status against current primary lists.
- Can a health plan integrate Fonteum data through an API?
- Fonteum exposes Practitioner, PractitionerRole, Organization, Location, and HealthcareService resources through its FHIR R4 surface, plus an NDJSON bulk-export workflow. Source and observation metadata varies by resource and field; the CapabilityStatement does not establish universal provenance or current coverage. The exclusion check is also available as a single-NPI REST call.
- Is the data free, and what does the pilot tier add?
- The federal datasets behind directory accuracy and screening — CMS NPPES, CMS PECOS, and the OIG LEIE with its companion exclusion lists — are published openly. The exclusion surface is browsable at /sanctions, and research downloads and methodology notes are at /research. The scoped pilot tier, starting at $2,500/mo, adds custom network-scoped exports and integration support. Source and observation metadata is included where the underlying response supplies it; it is not universal.
Request a directory-accuracy pilot.
Scope a custom NPPES + PECOS + exclusion export for your provider network. Free public data at /research and /sanctions. Pilot tier from $2,500/mo.
- /sanctions → OIG LEIE + exclusion-ring surface — loaded LEIE rows.
- /use-cases/payer-credentialing → Credentialing data with field-level federal citation.
- /docs/fhir → FHIR R4 US Core 6.1.0 endpoint reference and CapabilityStatement.
- /data-provenance → Field-level provenance pipeline for NPPES, LEIE, and PECOS.