North Carolina Medicaid has released a requirement that providers must screen for individual and entity exclusions, which means that some doctors, clinics, and employees may be excluded from Medicaid reimbursement.
Here are more details on the requirement and specifications:
http://www.ncdhhs.gov/dma/bulletin/0412bulletin.htm#med
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***If you have additional questions about this Medicaid change, please contact NC Medicaid DMA Program Integrity at 919-647-8000.
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To find any exclusions in your employee and doctor lists, perform the following steps
The report will print is a list of your employees and doctors that are excluded with the exclusion type.
The OIG list compares the first and last name and date of birth to your agency employee and doctor list. If a name matches, then it shows up in the report. The report will list where they were when the sanctions were levied. If a name in your database shows up, you'll need to do research to find out if it is indeed your employee or someone else.
Because there is limited information to compare, there may be multiple entries for one person.
Note: Barnestorm is not able to delete names from the report. The names come straight from the Individual and Entity Exclusion list database.
You will not receive payment from Medicaid for any services directed or prescribed by excluded physicians,
or for any services performed by excluded employees.
Further, they can recoup payments made for those services when OIG issues are found during an audit.
To look up exclusions of prospective doctors and employees, use the LEIE web site: http://www.oig.hhs.gov/fraud/exclusions.asp.
Barnestorm does not have any additional information about the exclusion program, excluded doctors,
excluded employees, or how the program works, so please direct your questions to NC Medicaid.