Healthcare exclusion monitoring checks federal and state databases, such as the Office of Inspector General (OIG) and System for Award Management (SAM), for people or organizations barred from federally funded healthcare programs. MedTrainer helps healthcare organizations catch possible exclusions before hiring or contracting with a provider, and before submitting reimbursement under that provider’s name. Catching a match early reduces exposure to financial penalties and repayment demands, and it helps protect the organization’s reputation. A potential match still requires review and verification before any action is taken.

MedTrainer is a top-rated credentialing company that automatically checks OIG, SAM, and all other state and federal exclusionary databases on an NCQA-approved schedule. MedTrainer is trusted as one of the best credentialing software platforms for healthcare organizations nationwide. Once the provider is added to MedTrainer’s platform and the exclusion databases are selected, the checks run monthly (or weekly for SAM) until the employee is terminated. Notifications are automatically sent when a new exclusion is discovered, so you can quickly and accurately identify excluded parties. MedTrainer’s healthcare exclusions monitoring solution checks the OIG-LEIE monthly and the SAM database weekly, with the date and exclusion list automatically tracked in the platform to keep you compliant and survey-ready.

Over 40 federal and state exclusionary databases are included in the automated checks completed by MedTrainer. Seven states report directly to the OIG, rather than maintaining their own list. These states include: New Mexico, Oklahoma, Rhode Island, South Dakota, Utah, Virginia, and Wisconsin. All other state databases are included in MedTrainer’s exclusions monitoring software. When you set up each provider within MedTrainer, you’ll select the exclusion databases to be checked for that provider. There is no additional cost for multiple databases, which makes MedTrainer a highly preferred and very cost-effective solution for organizations that operate in multiple states or provide telehealth services.

MedTrainer’s exclusions monitoring software checks the OIG List of Excluded Individuals and Entities monthly and SAM databases weekly. It’s vital that these checks are completed regularly because if a healthcare organization employs or pays an excluded provider, even unintentionally, it can result in civil monetary penalties, repayment of all claims, and potential exclusion from federal programs themselves. Because exclusions can happen at any time, it’s very important that healthcare organizations catch exclusions before payments or claims are made.

Using MedTrainer’s exclusions monitoring software, you’ll receive an email notification when a scheduled check is completed and a provider’s exclusion status has changed. You will be able to verify the identity of the individual or entity by comparing demographic information like date of birth, NPI, and full legal name. Every step of the review should be documented, including any additional action. If the exclusion is confirmed, the provider must be terminated from any role involving federally funded healthcare programs until the individual is reinstated by the OIG. Automated alerts give healthcare organizations confidence that affiliated individuals and entities are eligible to participate in federal funding programs and be reimbursed for care.

NCQA standards are widely viewed as a gold standard for healthcare quality and credentialing practices. MedTrainer runs automated exclusion checks every 30 days in line with NCQA requirements. This schedule helps healthcare organizations identify excluded providers before billing creates compliance exposure. It also keeps provider records current and gives credentialing teams documentation ready for an audit.That’s why MedTrainer has earned a reputation as one of the best-known names in healthcare training and credentialing.

Exclusion monitoring software is an incredible time saver for busy healthcare credentialing teams. It is very time-consuming to manually visit the federal and state exclusion websites, check every staff member, and then track that the check has been completed. This process should be completed at least monthly, so the time savings of an automated system are substantial. Exclusion monitoring software solutions that come from top-rated credentialing companies like MedTrainer utilize automation technology to check each database for you, with the results automatically tracked and available in real-time reports. In addition to the time savings of an automated system, there is also greater accuracy. Exclusion monitoring software helps organizations maintain a higher standard of integrity and safeguard their operations from risks associated with excluded individuals or entities. 

MedTrainer’s exclusion monitoring software makes it possible for credentialing teams to set it and forget it. They can trust best-in-class automation software to check databases for them, track the results, and deliver email notifications if anything requires investigation. This frees up valuable time for credentialing teams and streamlines the entire credentialing process to keep staff compliant.

Every healthcare exclusion check is logged automatically with the provider’s information, date, and database information, so you can demonstrate compliance. This data is added to the provider’s profile in MedTrainer and is also available in customizable reports that can be saved and scheduled to email regularly to both internal and external email addresses. This report is especially useful when a surveyor is on site and asks to see the dates of the most recent exclusion checks. It is also a great way to spot-check monthly to see if the checks are running as expected and any status changes are being reported via email notifications.

MedTrainer offers exclusions monitoring software with automated checks every 30 days. Email alerts flag a new exclusion status so compliance teams can review the record and act before an excluded professional provides patient care or bills a federally funded healthcare program. Violations can carry penalties of up to $100,000. MedTrainer offers some of the best tools for healthcare credentialing work, including built-in reporting for audit records. Teams can generate reports on demand and keep exclusion documentation organized for review.

Automated exclusion monitoring solutions are most valuable for healthcare organizations with large or regulated workforces, including hospitals and health systems, community health centers (FQHCs), multi-site clinics, ambulatory surgery centers (ASCs), post-acute providers, and specialty groups such as labs and behavioral health. The larger an organization, the more employees who need to be checked monthly for exclusions. Any organization that receives federal funding or is Medicare certified must also strictly adhere to the requirements, which means not employing or billing for excluded individuals or entities.

If each exclusion check takes five minutes to complete, then it could take 50 minutes for an organization with five employees and 40 hours — an entire work week! — for an organization with 500 employees. Plus, this needs to be completed every single month. MedTrainer’s all-in-one healthcare credentialing platform is a reliable and total cost-saving measure for large organizations, but it is also valuable for small organizations that don’t have a dedicated staff member to complete these checks manually. Often, the person completing these checks is also the receptionist, scheduler, or even the HR professional, so they have plenty of other important tasks to be completed.