Credential the provider and clear the payment — in the same check
Paying an excluded provider in a federally funded program is non-payable, recoverable, and penalized per item or service billed — whether or not you knew. TIN Comply verifies the NPI against the CMS registry, checks Medicare enrollment and opt-out status, screens OIG, SAM and 40+ state exclusion lists, and confirms the IRS TIN/name behind the payment — in one check, on one audit trail.
Portal, bulk, and API included. NPPES data updated weekly by CMS.
M. OKAFOR, M.D. · Individual (NPI-1)
Psychiatry · license PY-40218 (CO)
1420 GRANT ST STE 200, DENVER, CO
2011 · last updated this year
An excluded provider is a per-claim problem, not a paperwork problem
Services ordered, referred, or rendered by an excluded party are not payable under federal programs. The consequences attach per item or service billed — and they don't require that anyone knew.
Recoupment & penalties
Payments connected to an excluded party can be recovered after the fact, with civil monetary penalties assessed per item or service plus multiples of the amount claimed.
Monthly, not annual
Federal guidance points to screening employees and contractors monthly. A provider excluded in March who keeps billing until a December review is nine months of exposure.
The state-list gap
State Medicaid exclusions bind independently of the federal list. Screening OIG alone misses the provider a state program excluded — TIN Comply screens the state lists on the same check.
Enrollment is a three-state answer. We give you all three.
Most tools treat Medicare enrollment as a yes/no. The data has three states, and the third one — opt-out — is the one that quietly generates unpayable claims.
Enrolled
The provider appears in the CMS order-and-referring data, with their eligibility shown per benefit — Part B, DME, home health, power mobility, and hospice — not as a single flag.
Not enrolled
Reported as information, not as an alarm — cash-only practices legitimately aren't enrolled. The card says exactly what to do: confirm enrollment before billing federal programs for this provider.
Opted out
The provider filed an affidavit taking themselves out of Medicare — shown with the effective date and the end of the current period, and a reminder that opt-outs renew automatically every two years.
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NPI states that tell the truth Active, deactivated, no record, or not a valid number — each its own result. A deactivated NPI is not "not found," and a number that fails its check digit is reported as a typo, not a finding against the provider.
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The check digit runs before the lookup Every NPI carries a check digit. When it doesn't agree with the other nine digits, we say so — the usual cause is a transposed digit in transcription, and the card says exactly that instead of implying something about the provider.
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Individuals and organizations, told apart An organizational NPI shows the registered name and the authorized official on file. An individual shows credential, specialty, and license number with its issuing state.
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Exclusions and sanctions on the same check OIG, SAM, state Medicaid and licensure lists, and global sanctions — screened with tiered severity, so a registry entry never reads like an exclusion.
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The payment side, in the same call IRS TIN/name confirmed against IRS records, W-9 collected and validated — the half of provider onboarding that credentialing tools don't touch.
| Credentialing tools | AP tools | TIN Comply | |
|---|---|---|---|
| OIG + state exclusions | Yes | — | Yes |
| NPI validation | Yes | — | Yes |
| Enrollment & opt-out | Some | — | Yes |
| IRS TIN match | — | Yes | Yes |
| W-9 collection | — | Yes | Yes |
| Global sanctions | Some | Some | Yes |
| One audit trail | — | — | Yes |
Anyone who credentials on one screen and pays on another
Hospitals & health systems
Medical staff, contractors, and the vendor master — one screening obligation, currently three systems.
Healthcare staffing
High-volume onboarding where every placement needs exclusion screening and a valid W-9 before the first shift.
Billing & RCM companies
Ordering-and-referring checks plus exclusion screening across every client's provider file, via API.
Payers & networks
Network integrity screening at enrollment, with the dated evidence file regulators expect.
The rest of the vendor validation stack
One provider record. One verification. One audit trail.
Run your first provider check in minutes — portal, bulk, or API.