Fingerprinting FAQs

The federal regulation at 42 CFR 455.410(a) provides that a State Medicaid Agency (SMA) must require all enrolled providers to be screened according to the provisions of Part 455 subpart E.  These provisions require the agency to screen all provider applications for initial enrollment, re-enrollment or revalidation, enrolling a new practice location and/or a new taxonomy based on a categorical risk level of "limited", "moderate", or "high" (42 CFR 455.434).  N.C.G.S 108C-3 further defines providers that are impacted in North Carolina.

 

If a provider or provider categorical risk level is designated as "high" risk, the SMA must conduct the same "high" risk FCBCs for Medicaid purposes.

 

If the provider has completed fingerprint-based background checks with Medicare and it can be confirmed in PECOS, that can be accepted in lieu of new fingerprinting unless the provider’s categorical risk level has been adjusted due meeting Bump-Up criteria. See below for more information about the circumstances requiring Bump-Up.

FCBCs are required for all high categorical risk providers and owners who have a 5% or greater direct or indirect ownership interest.  

NC Medicaid is required to adjust (Bump-Up) a provider's Categorical risk level from "Limited" or "Moderate" to "High" when any of the circumstances listed below occur: 

 

For all provider types, Bump-Up to "High" categorical risk is required:

• Under 42 CFR 455.450(e), State Medicaid Agencies must adjust the categorical risk level of providers when:
  • A payment suspension is imposed based upon a credible allegation of fraud, waste or abuse. The provider remains "High" risk for ten (10) years beyond the date of payment suspension.
  • A provider, owner, operator, or managing employee was excluded by the U.S. Department of Health and Human Services Office of Inspector General, the Medicare program, or a State Medicaid Program within the previous 10 years. The provider remains "High" risk for ten (10) years beyond the effective date of the exclusion.
  • An enrolling or revalidating provider has an existing Medicaid overpayment of $1500 or greater that is unpaid for more than thirty (30) days old and not under appeal.  The provider remains "High" risk while the overpayment is outstanding.
  • CMS or the State Medicaid Agency (SMA) in the previous six (6) lifted a temporary moratorium for a particular provider type and a provider was prevented from enrolling based on that moratorium.  This applies for enrollment at any time within six (6) months from the date the moratorium was lifted.
• North Carolina General Statute (NCGS) 108C-3(g) designates providers as "High" categorical risk when:

  • A provider, owner, operator, or managing employee was convicted of a disqualifying offense pursuant to NC G.S. 108C-4 but was granted an exemption by the Department and allowed to enroll, within the previous 10 years.

     

For provider types recognized by NC Medicaid but not Medicare, the following circumstances require Bump-Up under NCGS 108C-3(g) to "High" categorical risk:

• The Department has imposed a payment suspension based upon a credible allegation of fraud in accordance with 42 C.F.R. 455.23 within the previous 12‑month period. The provider returns to its original risk category not later than 12 months after the cessation of the payment suspension.
• The provider has incurred a Medicaid final overpayment, assessment, or fine to the Department in excess of twenty percent (20%) of the provider's payments received from Medicaid in the previous 12‑month period. The provider returns to its original risk category not later than 12 months after the completion of the provider's repayment of the final overpayment, assessment, or fine.

Yes, this adjustment to a provider's categorical risk level means:

1. The additional screenings required of the "High" risk level (site visit and fingerprinting) must be completed to maintain participation with NC DHHS programs. 
2. An Off-Cycle Revalidation must be completed two (2) years after the initial Bump-Up.  Once this off-cycle revalidation is completed, the provider will return to the usual five (5) year revalidation cycle. 

 

The Bump-Up provider will receive notification with additional information and instructions regarding the completion of fingerprinting and site visit. This may include payment of applicable application fees. 

1. The site visit will be initiated by NC Medicaid through Public Consulting Group (PCG), who will contract the provider to schedule a visit.   
2. Provider action is required to initiate the fingerprinting process. To submit the fingerprinting application, the Office Administrator should:
3. Navigate to the Status and Management Page
4. In the Fingerprinting Required section, select the NPI/Atypical ID listed on this letter and begin the application.
5. Complete and submit the application, which consists of only a few pages.

 

You will then receive forms to complete your fingerprinting. Note; If you choose a manual ten print card, YOU MUST mail the ten-print card and BOTH the "Applicant Information" and the "Electronic Fingerprint Submission Release of Information" forms to: 

NC State Bureau of Investigation

Criminal Information and Identification Section

Attention: Civilian Services Unit - DHHSDMA00

Post Office Box 29500

Raleigh, NC 27626-0500

 

Uploading the manual ten print card to the pending application is not required and does NOT complete the fingerprinting process.

Provider risk level indicators are defined on the Provider Permission Matrix under Column N (Risk Level Indicator). The Provider Permission Matrix is available on the NCTracks Provider Enrollment webpage under Quick Links on the right-hand side of the page. Please note that the risk category for certain providers can be adjusted (Bump-Up) to High categorical risk requiring fingerprinting and a site visit.

The person notified to complete a fingerprint-based background check will incur the cost of having their fingerprints taken, which may vary depending on location.

Locations for Fingerprinting services can be found on the NCTracks Fingerprinting FAQ page under Fingerprinting Resources section at the top of the page. Providers are encouraged to call their chosen location and confirm that information listed has not changed.

Fingerprinting results can be accepted from Medicare through PECOS. No other agency or entity’s fingerprint-based background check results can be accepted.

Managing employees are not required to be fingerprinted.

Results from a fingerprint-based background check cannot be shared between agencies. If you receive a request to complete the fingerprinting process through NCTracks, it must be completed to maintain NC Medicaid participation.

The fingerprinting notification will be sent to the Office Administrator's email listed in the NCTracks secure provider portal. 

No, providers should wait to be notified by NCTracks before having their fingerprints taken. A form will be generated by NCTracks with a unique case number. The case number on the form will ensure that the results from the fingerprinting can be matched to the provider application with NCTracks.

 

Fingerprinting done without the form generated by NCTracks, with a unique case number, will not be accepted to satisfy the fingerprinting requirement.

Out of State providers required to submit fingerprints can go to their local Sheriff’s Department.

We encourage live scan results, but if you receive your Fingerprinting card YOU MUST mail the ten-print card and BOTH the "Applicant Information" and "Electronic Fingerprint Submission Release of Information" forms to NC SBI for processing at:

 

NC State Bureau of Investigation
Criminal Information and Identification Section
Attention: Civilian Services Unit - "DHHSDMA00"
Post Office Box 29500
Raleigh, NC 27626-0500

 

Also, the "Electronic Submission Release of Information" form must be uploaded to the NCTracks application.

This section should be completed by the Official at the Sherriff’s Office at the time of fingerprinting.

The form is generated from what was entered in your NCTracks application therefore you should contact CSRA to withdraw the application. The application should then be submitted with the correct information and the form will be re-generated.

No, forms must be electronically uploaded to the provider’s record in NCTracks by using the following steps:

 

1. From the Submitted Applications section of the Status and Management page, the OA will see that any NPI that has a status of "In Review" will also have a hyperlink to Upload Documents.
2. Select Upload Documents, attach the form, and click Submit Now.
3. At this point the process is complete.

Forms mailed to NCTracks or the location under the Agency Section on the Electronic Submission Release of Information form will not be processed. The Electronic Submission Release of Information form MUST be uploaded into NCTracks to the provider record. Failure to meet the stated deadline will result in denial or termination.

Once fingerprinting results are on file at NCTracks, the results are valid for a full five-year period for an individual provider or any person with a 5 percent or greater direct or indirect interest ownership interest in the organization. An exception occurs if the provider's risk level is adjusted (Bump-Up), which requires fingerprinting more frequently. If you receive a request to complete the fingerprinting process through NCTracks, it must be competed to maintain NC Medicaid participation.