Clearing Inconclusive Exclusion Results in Sanctions Module

At times, there may not be enough information for our exclusion monitoring service (SureCheckUSA), to ensure that an individual user or TPM/vendor is not matching with any individuals or entities on federal or state exclusion lists. This article will detail how to find, and provide the requested information to clear most inconclusives.

This article will cover the following:

• Inconclusive Results Data Needed Report and Actions to Resolve
• Categories of Inconclusive Results and Actions to Resolve

Inconclusive Results Data Needed Report and Actions to Resolve

This report will give you basic data (SSN, DOB, EIN, NPI) that is required to clear most Inconclusives.

1. From the primary navigation menu in Compliance Manager, click on 'Sanctions' to open the SureCheckUSA Portal.
2. From the SureCheckUSA Portal, hover on 'Reports' and then select 'Inconclusive Results Data Needed' from the dropdown menu.
3. Click 'Download Report' to view a list of individuals and/or vendors where additional information is required to clear a possible inconclusive.
4. Review the report and enter the requested information into the user or TMP/vendor profile within Compliance Manager. See the articles below on how to do this.
   • How to Edit a User Profile
   • How to Edit a TPM/Vendor Profile
5. Once you have added the requested information into the SureCheckUSA portal, it may take time for them to review the updates, and clear inconclusive results for those users/entities that were updated. If no updates to the inconclusives have occurred within 10 business days after updating the requested information, please contact Healthicity Support for further assistance.

Categories of Inconclusive Results and Actions to Resolve

Below are examples of different inconclusive results categories. Different results may require different actions to be taken. These will be found in the Notes section for each user/TPM/vendor, for each sanction list that was included in the exclusion search.
Note: The example terminology provided below may differ from what you see in an inconclusive result note, and are only meant as a guide to identify the actions your organization may or may not need to take.

• Inconclusive results that will be resolved by adding the specified information into the user or TMP/vendor profile, within Compliance Manager. 
  Example 1: Inconclusive - need SSN and DOB to verify
  Example 2: Inconclusive - need middle name to verify
  Example 3: Inconclusive - need NPI to verify
  • How to Edit a User Profile
  • How to Edit a TPM/Vendor Profile
     
• Inconclusive results that require further follow-up by SureCheckUSA (exclusion screening vendor). 
  No action is needed from your organization at this time.
  Example 1: Waiting on a response from [list manager/state], to assist with clearing inconclusive result
  Example 2: Inconclusive - email sent
   
• Inconclusive results that require further follow-up by your organization, typically by verifying information with the user or vendor/TPM.
  Example 1: Inconclusive - determine/verify if individual has lived at [specified address]
  Example 2: Inconclusive - determine/verify if entity/vendor has ever done business in [specified city and state]
  Note: Results like these will require that you verify information with the user or TPM/vendor directly. If they confirm they have not not live at, or done business at the address specified in the result notes, you can add that information to the inconclusive Notes box, and click the No Match square. Please do not delete any existing notes in the Notes box, and only add the additional information that was used to clear the inconclusive. It is also helpful to include your name for record purposes. See below.