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 enrollment, including initial enrollment, re-enrollment, or revalidation, enrolling new practice locations 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.

Federal Regulation 42 CFR 455.434 and N.C. G.S. 108C-3 state there are certain providers and categories of providers that an SMA must designate "high" risk. If a provider or provider category is designated as "high" risk by Medicare, the SMA must apply the same "high" risk designation for Medicaid purposes.

In accordance with Title 42 CFR 455.434 and 42 CFR 455.450 ( c ), fingerprint-based background checks are required for all high categorical risk providers and their owners who have a 5% or greater direct or indirect ownership interest as a condition of enrollment in the NC Medicaid and Health Choice Program. Under Medicare regulations at 42 CFR 424.518 (c), newly enrolling home health agencies and newly enrolling Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are designated "high" risk. N.C.G.S 108C-3 further defines providers that are impacted in North Carolina.

In accordance with federal regulation 42 CFR 455.450; the SMA may adjust a provider or supplier's screening level from "Limited" or "Moderate", to "High" if any of the following occur:

1. SMA has imposed a payment suspension within the last 10 years;
2. If the provider has been excluded from Medicare by the OIG;
3. If the provider has had billing privileges revoked by CMS within the previous 10 years;
4. If the provider has been excluded from any Federal Health Care Program;
5. If the provider has been subject to any final adverse action, in the previous 10 years;
6. If the provider has been terminated or is otherwise precluded from billing Medicaid; or if SMA lifts a temporary moratorium for a provider or supplier type and a provider or supplier that was prevented from enrolling based on the moratorium, applies for enrollment as a Medicare provider or supplier at any time within 6 months from the date the moratorium was lifted. N.C.G.S 108C-3 further defines providers that are impacted in North Carolina.

Provider types designated by categorical risk are defined in federal regulations 42 CFR 455.450, 42 CFR 424.518, and N.C. G.S 108C-3.

The relevant individuals who are required to undergo the fingerprint-based background check will incur the cost of having their fingerprints taken, and the cost may vary depending on the location.

No, the results from a fingerprint-based background check cannot be shared. A criminal history is good for a one-time fitness determination. Any subsequent determinations must be based on a fresh criminal history records check with fresh fingerprints.

You will need to get fingerprinted at any one of the LiveScan locations. Locations for Fingerprinting services can be found on the NCTracks portal: Fingerprinting Locations.

Managing employees are not required to be fingerprinted. If a provider has completed the fingerprint requirement in their home state or with Medicare, NC will try to confirm prior to asking for them to do fingerprinting in NC.

Please click on the link below for more information about the fingerprinting requirement as well as a list of locations: Fingerprinting Information and Locations.

No, the results from a fingerprint-based background check cannot be shared. A criminal history is good for a one-time fitness determination. Any subsequent determinations must be based on a fresh criminal history records check with fresh fingerprints.

Providers designated as "high categorical risk" (under 42 CFR 424.518c and NCGS 108C-3g) will be required to comply with the requirements for fingerprint-based criminal background checks. The Individuals will receive notification of the fingerprinting requirement after the implementation date July 30, 2017. Fingerprinting should not take place until notification is received to do so.

For additional information about the fingerprinting requirement, please click on the following links:

• Medicaid Bulletin
• Fingerprinting FAQ

The fingerprinting notification will be sent to the Office Administrator's email listed in the NCTracks portal. Live scans are the preferred method for sending fingerprinting information.

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.

If a provider has completed the fingerprint requirement in their home state or with Medicare, NC will try to confirm prior to asking for them to do fingerprinting in NC.

We encourage live scan results, but if you receive your Fingerprinting card you must mail it to the SBI for processing at NCSBI/Applicant Unit 3320 Garner Road Raleigh, NC 27626. The Electronic Submission Release of Information form is still required to be uploaded to NCTracks.

This section should be completed by the Official at the Sheriff’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. Instructions for uploading the form:

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. Once the link is selected, the OA will be able to browse for and attach the form.
3. Select the Upload Documents link found under the Fingerprint Evidence Documents section.
4. At this point the process is complete, and the provider will be able to go to the Status and Management page for an updated application status.

For most providers, fingerprinting results on file at NCTracks are valid for six months. However, a 2021 revision to federal regulations at 42CFR 424.518)(D) changes the time period for which fingerprint results are valid from six months to five years for some providers. Once fingerprinting results are on file at NCTracks, the results are valid for a full five-year period for a provider or any person with a 5 percent or greater direct or indirect ownership interest in the provider, who has submitted a set of fingerprints within the past 5 years, as the owner on a separate and newly enrolling provider. NC Medicaid will rely on the results from the previous fingerprint submission.