docs: add verified NPI services/pricing + companion-db analysis (217k overdue revalidations)
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@ -267,3 +267,139 @@ committing volume; these vendors change rates and gate some behind sales.
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- Always personalize with the detected deficiency + a **QR code / short URL** to
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- Always personalize with the detected deficiency + a **QR code / short URL** to
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the relevant free lookup tool — that QR is our tracking + conversion bridge,
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the relevant free lookup tool — that QR is our tracking + conversion bridge,
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the same role the email CTA plays today.
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the same role the email CTA plays today.
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---
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## 6. NPI Compliance Programs, "Expired" Signals & Suggested Rates
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### What we actually know is expired/dead (honest breakdown)
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NPPES alone has **no license/cert/revalidation expiry date**. The only hard
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"dead" status in the file is **NPI deactivation**. Real dateable "expired"
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signals come from FREE companion databases joined to NPPES by NPI or name.
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| Source | What it proves is expired/wrong | Hook |
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|---|---|---|
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| NPPES (deactivation cols 39-41) | NPI deactivated — cannot bill | NPI reactivation (HARD) |
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| NPPES (Last Update col 38) | Record stale (not "expired", a nudge) | NPPES update |
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| **CMS PECOS Revalidation list** | **Medicare revalidation due/overdue date (5-yr)** — the real dateable hook | Revalidation filing (flagship) |
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| **OIG LEIE** | Provider EXCLUDED from federal programs | Exclusion remediation (urgent) |
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| **SAM.gov exclusions** | Debarred / additional exclusions | Screening + remediation |
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| State medical board lookups | License itself expired (not in NPPES) | License renewal |
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> Flagship analog to FCC RMD recertification = **CMS Medicare revalidation due
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> date**, joined to NPPES by NPI. That is the genuine "your X expired" signal.
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### Programs to sell (ranked by trigger defensibility)
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1. Medicare PECOS revalidation filing (flagship)
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2. NPI reactivation (hard NPPES signal)
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3. NPPES data update / attestation
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4. State license renewal monitoring / filing
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5. OIG/SAM exclusion screening + remediation
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6. CAQH profile attestation (re-attest ~every 120 days)
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7. HIPAA compliance package (universal, not detectable)
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8. Credentialing / re-credentialing with payers
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9. Taxonomy / enrollment cleanup
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### Suggested rates
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| Service | Price | Cadence | Notes |
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|---|---|---|---|
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| NPPES data update / attestation | **$149** | one-time | low-friction entry product |
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| NPI reactivation | **$249** | one-time | hard trigger |
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| Medicare PECOS revalidation filing | **$399** | every 5 yrs | flagship, high stakes |
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| State license renewal (per license) | **$149/license** | annual/biennial | recurring |
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| OIG/SAM exclusion screening | **$99/yr** ($19/mo) | recurring | sticky subscription |
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| CAQH attestation/maintenance | **$249/yr** | recurring | high-churn pain |
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| HIPAA compliance package | **$799–$1,499** | one-time + annual | biggest ticket |
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| Credentialing (per payer) | **$199/payer** | as needed | volume add-on |
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| **Provider Compliance Bundle** | **$599–$899/yr** | annual subscription | revalidation watch + exclusion screening + NPPES upkeep |
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Pricing logic: solo/small providers are price-sensitive, but fear of losing
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Medicare billing privileges (revalidation, exclusion) supports premium pricing on
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those two. Data-update products stay cheap as door-openers. The **annual bundle**
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is the goal — mirrors the trucking compliance-bundle model for recurring revenue.
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### Recommendation
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Lead with **Medicare revalidation** (real dateable expiry from the free CMS list,
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like FCC RMD recert), use **NPI-deactivated** + **stale-NPPES** as secondary
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triggers, package into a **$599-899/yr Provider Compliance Bundle**.
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---
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## 7. Companion Databases — VERIFIED (downloaded & inspected)
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All free, all joinable to NPPES by **NPI**. Counts below are from the live files
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pulled on the session date. This is the data that turns "stale record" into a
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real, dateable "your X expired" hook.
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### 7.1 CMS Revalidation Due Date List (the flagship)
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`revalidation_base.csv` — **~2.9M rows, 2.42M distinct NPIs.**
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Columns: Enrollment ID, **National Provider Identifier (NPI)**, First/Last Name,
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Organization Name, Enrollment State Code, Enrollment Type, Provider Type Text,
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Enrollment Specialty, **Revalidation Due Date**, **Adjusted Due Date**,
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Individual Total Reassign To, Receiving Benefits Reassignment.
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**Verified population:**
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- **261,878 enrollments have a concrete due date set** (rest are "TBD" = CMS
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hasn't scheduled them yet).
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- **217,968 are PAST DUE (overdue revalidation)** — these are the hottest leads.
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- 43,910 are upcoming (future-dated) — perfect for "due soon" pre-emptive offers.
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This is the direct analog to the FCC RMD recertification date. Sell **Medicare
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PECOS revalidation filing ($399)** to the 217,968 overdue + watch service to the
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upcoming ones. Join to NPPES to get their address/phone for outreach.
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### 7.2 OIG LEIE (Exclusions)
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`UPDATED.csv` — **83,256 excluded providers/entities.**
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Columns: LASTNAME, FIRSTNAME, MIDNAME, BUSNAME, GENERAL, SPECIALTY, UPIN, **NPI**,
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DOB, ADDRESS, CITY, STATE, ZIP, EXCLTYPE, EXCLDATE, REINDATE, WAIVERDATE, WVRSTATE.
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**Verified:** only **8,608 have a valid joinable NPI** (most exclusions predate
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NPI or are entities w/ `0000000000`). Use this two ways:
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- As a **screening product** sold to OTHER providers ($99/yr) — "we check you and
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your staff against LEIE monthly."
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- As a **remediation hook** to the 8,608 excluded-with-NPI (reinstatement help),
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though excluded providers are a harder, riskier audience.
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### 7.3 Medicare Opt-Out Affidavits
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`OptOut_*.csv` — **56,300 opt-out affidavits.**
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Columns: First/Last Name, **npi**, Specialty, **Optout Effective Date**,
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**Optout End Date**, address, City, State, Zip, Eligible to Order and Refer,
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Last updated.
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**Verified:** **22,379 have an opt-out period ending within 12 months.** Opt-out
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auto-renews every 2 years unless cancelled — a real dateable event. Sell
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**opt-out renewal / re-enrollment decision support**.
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### 7.4 Order & Referring File
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`OrderReferring_*.csv` — **~2.0M rows.**
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Columns: **NPI**, LAST_NAME, FIRST_NAME, PARTB, DME, HHA, PMD, HOSPICE (Y/N flags).
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Tells us which providers are eligible to order/refer for each program. Use to
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**qualify leads** (a provider missing eligibility they should have = enrollment
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gap = service opportunity).
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### 7.5 PPEF Public Provider Enrollment
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`PPEF_Enrollment_Extract_*.csv` — **~2.98M rows.**
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Columns: **NPI**, MULTIPLE_NPI_FLAG, PECOS_ASCT_CNTL_ID, ENRLMT_ID,
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PROVIDER_TYPE_CD/DESC, STATE_CD, names, ORG_NAME. This is the authoritative
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"who is actively enrolled in Medicare" list. Join against NPPES to find:
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- NPPES providers **NOT in PPEF** = not Medicare-enrolled (enrollment opportunity).
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- Cross-check enrollment state vs NPPES practice state (mismatch = cleanup).
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### Join architecture
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```
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NPPES (10M providers, addr/phone/fax) <- outreach contact + base universe
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⨝ NPI ⨝
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Revalidation Due (217,968 overdue) <- flagship "expired" hook + $399
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⨝ NPI ⨝
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LEIE (8,608 excluded w/ NPI) <- screening product + urgent flag
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⨝ NPI ⨝
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Opt-Out (22,379 ending <12mo) <- renewal hook
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⨝ NPI ⨝
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PPEF / Order-Referring <- enrollment gaps / lead qualification
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```
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### Headline takeaway
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The single best, defensible, dateable hook is **217,968 providers with OVERDUE
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Medicare revalidation**, each enrichable with NPPES address/phone/fax for
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outreach. That is a larger and harder-deadline audience than the FCC RMD list,
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and the $399 revalidation filing is a clean flagship product.
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