North Carolina Exclusion List

An excluded provider is an individual or entity that cannot bill or cause services to be billed to Medicare, Medicaid or NC Health Choice. DHHS works diligently to prevent excluded providers from participating in NC Medicaid and NC Health Choice to comply with federal regulations.

The North Carolina Medicaid Provider Termination and Exclusion list is updated monthly. The termination or exclusion is in effect until the provider is removed from this list.

• Why it matters: Services ordered, referred, or rendered by excluded parties are non‑payable; employing or contracting with excluded providers risks recoupment and civil monetary penalties.
• What to verify: Legal name and aliases, NPI/Medicaid ID, license/board status, date of birth (if available), last known city/state, and exclusion effective/end dates.
• Update cadence: Typically updated monthly by the state. Record the file’s “as of” date and screen at hire and monthly thereafter.
• Compliance tips:
  • Cross‑check with OIG LEIE and SAM.gov and retain dated evidence of each search.
  • Add system blocks to prevent ordering/prescribing by excluded providers.
  • Document remediation steps for positive matches (schedule removal, claim holds, notifications).