What data do I need to gather for exclusion monitoring?

Exclusion monitoring is a matching game between your organization's data and information at the primary source. The data your organization collects varies by population. You’ll likely have more information about your employees than your vendors or provider networks.

To determine an exclusion with high confidence, you need to verify that one or more pieces of uniquely identifiable data match. For example, matching an exclusion on a name only is not enough to be conclusive, since some names are quite common. Matching an exclusion on SSN and NPI is a high-confidence, high-quality match.

For an Individual:

  • Full Legal Name  (including any previous names)
  • Date of Birth
  • Address
  • Social Security Number (SSN) or Tax Identification Number (TIN)
  • National Provider Identifier (NPI) Number

For an Entity:

  • Entity’s Legal Name
  • Address
  • TIN or Employer Identification Number (EIN)
  • Owner Information (Including TIN)

Remember, not all primary sources contain all of the information above. But it’s important to gather as much information as you can to ensure that your results are accurate.