Automatically monitor your providers, employees, contractors, and vendors for OIG, SAM, State Medicaid, and other exclusion and provider-status changes. Get automatic alerts and maintain an audit-ready record of your screening activity.
Who is this for?
Continuous Monitoring Is Ideal For Organizations That:
- Employ large numbers of healthcare professionals
- Use temporary or contract healthcare workers
- Work with outside vendors
- Operate multiple locations
- Have recurring provider turnover
- Participate in Medicare or Medicaid
- Need documented compliance processes
- Don’t want staff manually checking exclusion databases every month
Continuous Exclusion Monitoring — $89/Month
Everything Included
✓ Continuous monitoring
✓ OIG LEIE
✓ SAM
✓ State Medicaid exclusion lists
✓ Automatic exclusion-change notifications
✓ Monitoring dashboard
✓ Primary-source verification
✓ Audit-ready reports
✓ Screening notes and documented evidence
✓ Provider list management
$89.00/month
No contract / Cancel anytime
What is Continuous Exclusion Monitoring?
Continuous exclusion monitoring is an automated process that regularly checks healthcare providers, employees, contractors, and other individuals or entities against exclusion and provider-status databases. When a new exclusion or a change in monitored status is identified, the organization can receive a notification and review the result before taking appropriate action.
HealthProviders DB provides continuous monitoring with monthly updates to OIG, SAM, and State Medicaid exclusion data; automatic exclusion-change notifications; a monitoring dashboard; primary-source verification tools; and audit-ready screening records.
Why Continuous Exclusion Monitoring Matters
Catch changes without manually checking every provider
Exclusions and provider-status information can change after a provider has already been hired or contracted. OIG advises healthcare entities to routinely check the LEIE and says that monthly screening best minimizes potential overpayment and CMP liability because the OIG updates the LEIE monthly.
Reduce manual compliance work
Instead of repeatedly downloading databases and manually checking provider records, maintain a monitored list and receive notifications when relevant changes are identified.
Maintain documentation
Keep screening results, verification information, notes and evidence available for compliance and audit purposes.
Know what changed
The dashboard should make it easy to distinguish exclusions, possible matches, reinstatements, deactivations and other monitored statuses.
Avoid Civil Monetary Penalties
Providers excluded by the Office of Inspector General (OIG), terminated by any State Medicaid Agency, or debarred from receiving federal contracts, grants, or financial assistance cannot participate in federally funded healthcare programs. This includes Medicare, Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP), federally funded healthcare programs. Additionally, the Centers for Medicare & Medicaid Services (CMS) has the authority to revoke billing privileges, prohibiting the provider from participating in Medicare.
Providers are liable for overpayments made for any items or services provided by any excluded person for which the provider received reimbursement from federal healthcare programs. Additionally, the provider may face Civil Monetary Penalties (CMP) if they fail to ensure that proper exclusion screening has been conducted.
There are over 320,000 exclusions reported in total by the OIG, SAM, and State Medicaid Agencies. Save yourself a lot of time and effort—Upload your provider list, and we will deliver you a complete, consolidated Exclusion Report in minutes!
What We Monitor
HealthProviders DB features over 9 million healthcare provider profiles and over 320 thousand state and federal exclusions, and is updated daily from hundreds of state and federal databases. We go beyond importing exclusion lists to include state licensing active status and board disciplinary actions.
As databases are imported, they are matched with the healthcare provider’s profile. You are immediately notified if a change happens to anyone on your managed provider list.
What Databases Does Exclusion Monitoring Check?
| Database | What it identifies |
|---|---|
| OIG LEIE | Individuals and entities excluded from federal healthcare programs |
| SAM.gov | Federal exclusions and debarments |
| State Medicaid | State-specific Medicaid exclusions, terminations, and sanctions |
| State Licenses | State-specific licensing and disciplinary actions |
| CMS | Medicare opt-outs and revoked providers |
| FDA | FDA debarments and clinical investigator disqualifications |
| NPI | NPI deactivation status |
And additional federal and state data sources as applicable.
What You Get
With the Continuous Exclusion Monitoring subscription, you can easily add and remove providers, employees, vendors, and contractors for ongoing exclusion monitoring. The consolidated & comprehensive Exclusions Report is always current and accessible anytime through the Exclusions Dashboard. Additionally, you can save notes and documented verification evidence that is included with the Exclusion Report for audit review.
Automatic Change Notifications
Know when something changes without manually checking every provider.
Centralized Monitoring Dashboard
See your monitored providers, exclusions, verifications, reinstatements, Medicare opt-outs, and NPI deactivations in one place.
Primary-Source Verification
Review the underlying federal or state source before taking action.
Audit-Ready Documentation
Maintain reports, notes, and supporting evidence of your screening activity.
Easy Provider Management
Add, remove, or update providers as your workforce and contractor relationships change.
Who Needs Continuous Exclusion Monitoring?
Organizations that employ, contract with, or otherwise work with individuals and entities whose services may be paid for by federal healthcare programs should establish an appropriate exclusion-screening process.
- Hospitals & Health Systems
- Physician Practices
- Nursing & Long-Term Care
- Home Health & Hospice
- Ambulatory Surgery Centers
- Pharmacies
- Medical Equipment Suppliers
- Billing & Coding Companies
- Healthcare Contractors
- Managed Care Organizations
An Exclusions Report You Can Actually Use
The Exclusions Report is designed to give you a consolidated view of your provider screening results, including the information needed to investigate and verify the exclusion matches.
The Exclusions Report includes:
- The provider’s full name and Addresses for identity and location matching.
- NPI Number and Deactivated Date for identity matching and active status checks.
- License Numbers, Active Status, and Expiration Date for license verification and current status review.
- Medicare Opt-Out Affidavit Start and End Dates for assessing Medicare participation status.
- Exclusion Date, Reason, Reinstatement Date, and Status of Exact, Possible, Reinstated, Deactivated, Opted-out, or Clear for identification and verification.
- Links to the exclusion primary source record on the reporting agency’s website for verification and collecting documented evidence.
Sample Exclusions Report
What happens when an exclusion is found?
When a potential exclusion or monitored status change is detected, the organization receives a notification and can review the provider’s details in the monitoring dashboard. The result can then be verified against the applicable primary-source record and documented before the organization takes action in accordance with its compliance policies.
The Exclusions Screening Report makes verifying found exclusions much easier by including links to the exclusion’s primary source record on the reporting agency’s website, enabling quick verification and the collection of documented evidence. With the Exclusion Report and your documented evidence from the agency website for each exclusion found, you’re audit-ready!
What to do with exact matches
Exact and reinstated matches should be verified through the primary source on the reporting agency’s website, using the link provided in the Exclusion Report to gather documented evidence of your due diligence.
What to do with possible matches
A screening result should not be treated as a final determination solely from a name match. Possible matches should be reviewed against identifying information such as NPI, name, address, and license information and verified against the applicable primary-source government record. Organizations should then follow their compliance procedures and applicable requirements.
What to do with opt-out matches
Healthcare providers that have opted out of Medicare cannot receive Medicare reimbursements. Opted-out matches have start and end dates. You can use the primary source link to get the Medicare Opt-out affidavit.
What to do with deactivated NPI matches
Deactivated NPI matches mean the number is no longer valid. You can use the primary source link to get evidence from the NPI registry.
Do you need One-time Exclusion Screening?
One-time Exclusion Screening is a healthcare compliance batch exclusion screening service that compares your list of healthcare providers against the OIG LEIE, SAM, CMS, NPI, FDA, and State Medicaid exclusion lists, delivering a consolidated & comprehensive downloadable exclusion screening report—starting at just $25 for up to 100 providers screened.
One-time Exclusions Screening is useful for new provider onboarding, credentialing, vendor screening, or periodic compliance checks. It’s ideal for small organizations with a limited number of providers that want to verify exclusions and gather documented evidence themselves.
One-time Exclusions Screening is used for:
- New provider onboarding
- A compliance review
- An internal audit
- Credentialing
- Enrollment
- Vendor screening
- Contracting
- Periodic compliance checks
- A specific provider population
One-time Screening vs Continuous Exclusion Monitoring
| One-Time Screening | Continuous Monitoring | |
|---|---|---|
| Best for | Occasional screening | Ongoing compliance |
| Provider list | Upload when needed | Continuously maintained |
| OIG LEIE | ✓ | ✓ |
| SAM | ✓ | ✓ |
| State Medicaid | ✓ | ✓ |
| Recurring monitoring | — | ✓ |
| Automatic change alerts | — | ✓ |
| Monitoring dashboard | — | ✓ |
| Saved screening evidence | — | ✓ |
| Price | $25/100 providers | $89 Monthly subscription |
Already screened your providers? Continuous monitoring keeps watching them.
Frequently Asked Questions
What information do I need to screen a provider?
The NPI number is the preferred identifier when available. Provider name, address, and state license information can also help identify and verify potential matches.
What format should my provider list be?
Your provider list should be uploaded as an Excel, CSV, or text file. Include the provider’s NPI number, name, address, and any required license numbers.
What does the exclusion screening report contain?
The report includes provider identity information, NPI status, license information, Medicare opt-out status, exclusion status, exclusion dates, exclusion reasons, reinstatement information, and links to primary-source records for verification.
How quickly will I receive my report?
The Exclusions Report is available at any time from the Exclusions Dashboard.
What happens with my uploaded provider list?
Your uploaded provider list is securely saved in the system, and you can remove it at any time.
Does a screening result guarantee that a provider is eligible to participate in federal healthcare programs?
Screening results are provided as informational compliance-screening data. Organizations should independently verify potential matches and determine the appropriate action in accordance with applicable laws, regulations, contracts, and organizational policies.
What should I do if an excluded provider is found?
A screening result should not be treated as a final determination solely from a name match. Potential matches should be reviewed against identifying information such as NPI, name, address, and license information and verified against the applicable primary-source government record. Organizations should then follow their compliance procedures and applicable requirements.
Is exclusion screening a requirement?
Federal database checks under 42 CFR § 455.436 require all Medicare Advantage Plans, State Medicaid Programs, and Medicaid Managed Care Organizations to confirm providers’ exclusion status through routine checks.
Providers excluded by the Office of Inspector General (OIG), terminated by any State Medicaid Agency, or debarred from receiving federal contracts, grants, or financial assistance cannot participate in federally funded healthcare programs. This includes Medicare, Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP), federally funded healthcare programs. Additionally, the Centers for Medicare & Medicaid Services (CMS) has the authority to revoke billing privileges, prohibiting the provider from participating in Medicare.
How often should exclusion screening be done?
OIG recommends that healthcare organizations screen employees and contractors before employment or contracting and periodically thereafter. Because the OIG LEIE is updated monthly, OIG states that monthly screening best minimizes potential overpayment and civil monetary penalty liability. Certain federal programs and state requirements may impose additional screening obligations. Organizations should determine the requirements applicable to their programs, contracts, and state.
Who should be included in Exclusion Screening?
- Physicians
- Nurses
- Nurse practitioners
- Physician assistants
- Pharmacists
- Dentists
- Therapists
- Other healthcare professionals
- Administrative personnel
- Contractors
- Vendors
- Billing companies
- Medical equipment suppliers
- Transportation providers
- Other individuals/entities whose services may be reimbursed by federal healthcare programs
HealthProviders DB provides data and screening services to assist organizations with exclusion screening and compliance processes. Screening results should be independently reviewed and verified, particularly when a potential match is identified. The service does not constitute legal, regulatory, or compliance advice and does not guarantee that an organization will satisfy its legal or regulatory obligations.