Missouri Exclusion List

The Missouri Department of Social Services, MO HealthNet Division (MHD), maintains a list of providers whose participation in the Medicaid program has been terminated or excluded for cause. Reasons include fraud, abuse, licensure actions, or other violations of federal and state regulations. Once excluded, an individual or entity may not receive reimbursement for any services rendered or ordered under Medicaid until formally reinstated.

• Why it matters: Billing or contracting with excluded providers exposes your organization to claim denials, repayment demands, and potential civil monetary penalties. Even indirect relationships—such as subcontractors or referring physicians—can create compliance risk if the excluded individual is tied to a Medicaid claim.
• What to verify: Provider’s full legal name and known aliases, NPI or Medicaid ID, license number and board status, sanctioning authority, and the effective and end dates of the exclusion. Verify that the provider has not been reinstated before authorizing any claims or credentialing actions.
• Update cadence: Missouri updates its exclusion list monthly in alignment with 42 CFR § 455.416. Always reference the latest file directly from the state website rather than stored copies to ensure accuracy.
• Compliance tips:
  • Integrate automated monthly checks against both the Missouri list and the OIG LEIE.
  • Maintain dated evidence of each screening, including search parameters and results.
  • Establish claim-hold procedures for any positive matches until fully resolved.
  • Notify credentialing, billing, and compliance teams immediately upon identification of a match or reinstatement.