Exclusion Sanction Questions FAQs

Yes, they are required on all enrollment, re-enrollment, and reverification applications including MCRs.

For each exclusion sanction question answered affirmatively, documentation clearly indicating the final resolution must be submitted with every application (initial enrollment, MCR, re-verification and re-enrollment application) regardless of the date last submitted and for every exclusion sanction question answered yes. The documentation may be applicable to more than one sanction question. In addition, a thorough written explanation for each question answered affirmatively must be signed and dated by the responsible party within six months of the application date. At the end of the application, you may upload the required documentation.  After application submission, if additional supplemental document is requested, you may upload documentation from the Status and Management page using the Upload button associated with the pending application.    

 

An individual can obtain copies of their court records by visiting the Clerk of Superior Court's office in the county where the case was filed, or by submitting a request online, by mail, or in person via the North Carolina Judicial Branch website.

County Clerk of Court: For state-level, criminal, civil, and estate cases, the local Clerk of Court is the primary custodian. Records can be viewed in person, and copies can be made for a fee.

Background Checks: For personal criminal records, individuals can contact the NC State Bureau of Investigation (SBI).

 

A full explanation of the 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 any individual listed with a managing relationshipin 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 as stated in https://www.nctracks.nc.gov/content/public/providers/provider-communications/2023-Announcements/Update-to-Documentation-Requirements-for-Exclusion-Sanction-Questions.html. 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.

 

Failure to disclose or provide documentation results in application denial or termination of the provider record. Failure by currently enrolled providers to disclose adverse actions within 30 days as contractually required will result in termination of their NCTracks provider record.

 

A denial/termination due to failure to disclose is a “for cause” termination, reportable to the Centers for Medicare & Medicaid Services (CMS) Data Exchange System (DEX), making it imperative that providers thoroughly read each Exclusion Sanction question and respond appropriately.

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. 

An expungement is a court-ordered process, different from a pardon, that makes information about an individual’s criminal history unavailable to the public. In an expungement, court records are destroyed. While records are generally inaccessible, some government agencies are permitted to collect information about expunged records.

 

NCDHHS requires providers enrolling in NC Medicaid to disclose expungements. When petitions for expungement are granted, the clerk of superior court sends the petitioner a certified copy of a Final Order. This Final Order document should be submitted with the NC Medicaid provider enrollment application as verification of expungement.

Once the record is expunged by the court system, the Final Order is destroyed along with the case file and court clerks are no longer able to furnish copies of the Final Order. 

 

Providers might be able to obtain a copy of a Final Order from the following:

State Bureau of Investigation

Attn: Expungement Unit

PO Box 29500

Raleigh, NC 27626

 

NC Administrative Office of the Courts

Court Services Division

Attn: Records Officer

PO Box 2448

Raleigh, NC 27602