Beginning January 28, 2024, five new additional exclusion sanction questions will be added to enrollment, re-enrollment, full MCRs, office administrator (OA) and re-verification applications:
- L. Has the enrolling provider had any liability insurance carrier canceled, refused coverage, or rated up because of unusual risk or have any procedures been excluded from coverage?
- M. Has the enrolling provider ever practiced without liability coverage?
- N. Does the enrolling provider have any medical, chemical dependency or psychiatric conditions that might adversely affect your ability to practice medicine or surgery or to perform the essential functions of your position?
- O. Has the enrolling provider’s hospital and/or Clinic privileges ever been limited, restricted, reduced, suspended, revoked, denied, not renewed, or have you voluntarily surrendered or limited your privileges during or under the threat of an investigation or are any such actions pending?
- P. Has the enrolling provider had a professional liability claim assessed against them in the past five years or are there any professional liability cases pending against them?
All five questions are applicable to individual providers. However; only two of the questions will be applicable to organizations:
- L. Has the enrolling provider had any liability insurance carrier canceled, refused coverage, or rated up because of unusual risk or have any procedures been excluded from coverage?
- M. Has the enrolling provider ever practiced without liability coverage?
Affirmative answers to exclusion sanction questions on all applications require a written explanation AND supporting documentation.
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. Failure to disclose documentation related to an affirmative response will result in a denial of the application. A full explanation of the new documentation requirements can be found here.