Criteria for Supporting Documentation: Exclusion Sanction Questions

The requirements for responses to exclusion sanction questions C, D, F and J have been updated. Providers who answer "Yes" to these questions (as related to an affiliation) must provide supporting documentation that meets the following criteria (as it relates to the affiliated provider):

General identifying information about the affiliated provider or supplier, which includes:

• Legal name as reported to the Internal Revenue Service or the Social Security Administration (if the affiliated provider or supplier is an individual)
• “Doing business as" (DBA) name (if applicable)
• Tax identification number
• National Provider Identifier (NPI)
• Reason for disclosing as it relates to the provider, affiliated provider or supplier

Specific data regarding the affiliation relationship, including the following:

• Length of the relationship
• Type of relationship
• Degree of affiliation

Providers are encouraged to review these requirements carefully before submitting the supporting documentation to avoid application processing delays caused by insufficient information. If the requirements are not met, an application incomplete letter will be generated prompting the provider to submit the proper documentation