This policy applies to all UBMD practice plans who bill government programs including, without limitation, Medicare and Medicaid. Federal and state governments require healthcare providers to check the names of all providers, staff and agents/vendors against exclusionary databases. It is required that each UBMD practice plan check the following exclusionary databases (“Exclusionary Databases”) according the time frames listed below:
The following Exclusionary Databases must be checked monthly:
The following Exclusionary Databases must be checked against providers only when a provider is credentialed or re-credentialed:
If a match is found on any exclusionary database, the provider, staff member or agent/vendor should be immediately suspended. That person should be given the opportunity to appeal to the appropriate government agency to have his or her name removed from the Exclusionary Database or receive a waiver from the appropriate government agency.
If those actions are not successful, provider or staff member must be terminated from employment and the contract with the agent/vendor must be terminated.