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Feature · Exclusion screening

OIG, SAM and state Medicaid exclusion screening

Screen every provider, for every client, every month, without anyone remembering to do it. Possible matches go to your team to confirm or clear, the result stays on the provider's record, and a monthly attestation report sums it up.

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Lists checked

Federal and state lists, on a schedule

Exclusion checks done by hand happen when someone remembers. Credentik screens every provider automatically each month, and on demand whenever you add someone, against federal sources and the state Medicaid lists, and keeps the result on the provider’s record.

Want to see which states publish what? Our state Medicaid exclusion list directory covers all 50 states and DC.

Sources

  • HHS-OIG LEIE
  • SAM.gov exclusions
  • 19 state Medicaid exclusion lists checked automatically, plus others loaded from an export
  • CMS Medicare opt-out list
  • NPPES NPI registry (deactivations)
Adjudication

A possible match is a question, not a verdict

Common names produce false positives. Credentik sends each possible match to your team with the list entry beside the provider’s details, so the reviewer can compare NPI, license, location and dates, then confirm or clear it with a note. The decision and who made it are recorded.

Monthly attestation report

A monthly report summarizes who was screened, against which lists, what was found and how each possible match was resolved, ready to keep on file or share with a client or health plan.

Part of the credentialing file

Screening results prefill the OIG, SAM, state sanctions and Medicare opt-out elements on the provider’s verification checklist.

Setting up a screening program? Our OIG, SAM and state exclusion screening guide covers who to screen, how often, and what to do with a match.
Questions

Frequently asked

Which lists does Credentik check?
The HHS-OIG List of Excluded Individuals/Entities (LEIE), SAM.gov exclusions, the NPPES NPI registry and the CMS Medicare opt-out list, plus 19 state Medicaid exclusion lists checked automatically. Those 19 states publish a downloadable file that Credentik imports on a schedule; lists published only as a PDF or a search page can be loaded from an export.
How often are providers screened?
Automated monitoring screens every provider on the first of each month, in line with the OIG's guidance that monthly checks best minimize risk. You can also screen one provider, for example a new hire, or everyone on demand.
What happens with a possible match?
A name match is not treated as an exclusion. It goes to your team to review against identifiers such as NPI, license and location, and to confirm or clear with a note. Only a confirmed exclusion marks the provider as excluded; Medicare opt-out and preclusion are recorded as billing warnings.
Is automated monitoring on every plan?
Yes. Automated exclusion monitoring is included on every plan, starting with Solo.

Keep reading

DataState Medicaid exclusion lists, state by stateWhere every state publishes its Medicaid exclusion list, the format, and the federal lists to check too.Read more GuideHow to do OIG, SAM and state exclusion screeningWho to screen, which lists, how often, and what to do with a match.Read more FeatureCredentialing and primary source verification, in orderRequirement checklists, readiness scores, a PSV checklist with automated prefill, and committee review.Read more

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