Update to Documentation Requirements for Exclusion Sanction Questions

Effective Jan. 29, 2023, requirements for exclusion sanction question documentation will be updated. Currently, when an exclusion sanction question is answered ‘yes,’ providers must submit a complete copy of the applicable documentation or a written explanation of the supporting documentation. With this update, both will be required.

Please note the updated requirements below. If these requirements are not met, an ‘application incomplete’ letter will be generated, prompting the provider to submit the proper documentation.*

Answering Exclusion Sanction Questions

Exclusion sanction questions will be required upon submission of every new application (manage change requests (MCRs), re-verification and re-enrollment applications).

Failure to disclose documentation related to an affirmative response will result in a denial of the application. Background checks are performed for all applications. If a provider answers affirmatively during their initial enrollment, they must continue to answer affirmatively and disclose all applicable adverse legal actions in subsequently submitted applications. 

Documentation Required

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.

Supporting documentation may include but is not limited to:

  • Criminal complaint
  • Consent Order
  • Court documentation
  • Final Disposition

Documentation must be provided for every exclusion sanction question answered yes; however, the documentation may be applicable to more than one sanction question. Documentation may be uploaded at the same time/as one file.

Written Explanation Signed and Dated by Responsible Party

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.

  • For individual applications, the provider must sign and date the explanation
  • If the responsible party is an organization, the provider's office administrator must sign and date the explanation

The written explanation must include a reference to the reported adverse legal actions including date and the final resolution. 

Date Congruency

All dates must align between the documentation provided and dates reported in the application. This includes the date listed on legal documentation, the written explanation and reported in the Exclusion Sanction section of the application.

During the background check process, all dates will be checked for accuracy. Dates that do not align will delay the application process.

 

*NCTracks will inform the provider of the exact reason why the application was deemed incomplete, including itemization of the supporting documentation that is missing from the application.

 

 

 

 

 

 

 

 

 

 

 

 

 

M23006-R-2568