Exclusion Sanction Questions FAQs

Yes, they are required on all applications including MCRs. No, this requirement is not changing; sanction questions will still be required in all applications including MCRs.

Effective Aug. 9, 2020, additional supporting information may be required based on application responses or if your information is unable to be verified during the background check. As always, if you have answered yes to any of the provider sanction questions, at the end of the application you must upload or submit a complete copy of the applicable documentation clearly indicating the final resolution.

 

A full explanation of the new documentation requirements can be found at: https://www.nctracks.nc.gov/content/public/providers/provider-communications/2023-Announcements/Update-to-Documentation-Requirements-for-Exclusion-Sanction-Questions.html.

The Exclusion Sanction questions must be answered. All convictions (misdemeanors and felonies) must be disclosed regardless of how old the conviction is. (The only exception to this requirement is minor traffic offenses, such as a speeding ticket, expired registration, etc.) The questions must be answered for the enrolling provider, owners and agents in accordance with 42 CFR 455.100; 101; 104; 106 and 42 CFR 1002.3. If the answer to the Exclusion Sanction questions is yes, then documentation regarding the disposition of the action must be attached to the application. If a provider submits a written attestation, it must be on company letterhead and signed and dated by the person to whom the attestation applies. For a complete list of questions, go to the User Guides and Fact Sheets page and open either the How to Enroll in North Carolina Medicaid as an Individual Practitioner or How to Enroll in North Carolina Medicaid as an Organization user guide, located in the Enrollment and Re-verification section. These documents contain the list of sanction questions.

Go to the Provider User Guides and Training page and open either the How to Enroll in North Carolina Medicaid as an Individual Practitioner or How to Enroll in North Carolina Medicaid as an Organization User Guides located in the Enrollment and Re-Verification section. There is a hyperlink located in the Exclusion Sanction Information section of these documents that will display a complete list of the questions.

 

If you have answered “yes” to any of the provider sanction questions, at the end of the application you must upload or submit a complete copy of the applicable documentation. Effective Aug. 9, 2020, additional supporting information may be required based on application responses.

 

A full explanation of the new documentation requirements can be found at: https://www.nctracks.nc.gov/content/public/providers/provider-communications/2023-Announcements/Update-to-Documentation-Requirements-for-Exclusion-Sanction-Questions.html.

Beginning Jan. 28, 2024, five new additional exclusion sanction questions are included on the enrollment, re-enrollment, full MCRs, office administrator (OA) and re-verification applications

These additional questions are required in order for NC DHHS to be compliant with the National Accreditation for Quality Assurance (NCQA).  They are also standard questions contained in the NCDOI Uniform NC Application which allows NC DHHS to align with screening questions asked by most other health plan payers and health systems across the state of NC. 

This question is intended to ask whether or not the provider’s condition might adversely affect their ability to practice medicine, surgery, or perform the essential functions of their position.