Beginning Oct. 1, 2026, site visits mandated under 42 Code of Federal Regulation (CFR) § 455.432 will no longer be scheduled. The Public Consulting Group (PCG) is contracted by NC Medicaid to perform the federally mandated screening of Medicaid providers classified as moderate and high-risk. Providers will receive a notification from PCG that a visit will occur within a specified timeframe, rather than the traditional scheduled visit with a predetermined date and time.
Pursuant to 42 CFR § 455.432(b):
The State Medicaid agency must require any enrolled provider to allow CMS, its agents, its designated contractors, and/or the State Medicaid agency to conduct unannounced on-site inspections of any and all provider locations.
Pursuant to Section 7.c. of the NCDHHS Provider Administrative Participation Agreement:
Provider agrees to cooperate with all announced and unannounced site visits, audits, investigations, or program integrity activities conducted by Federal and State officials, Department personnel and/ or its legally authorized agents, contractors, or vendors, their successors and assigns for the purpose of certification and compliance surveys, inspections, medical and professional reviews, monitoring, and audits of costs and data relating to services to recipients.
Such visits, including unannounced visits, must be allowed at any time during normal hours of operation. Failure to grant prompt and reasonable access upon reasonable request may result in suspension of the Provider and/or of reimbursements or termination from participation in the North Carolina Medicaid program.
What Providers Can Expect
Providers subject to site visits on or after Oct. 1, 2026, should expect to receive a notification from Public Consulting Group (PCG) that a visit will occur within a specified timeframe. A site visit will not be scheduled on a specific date or time Oct. 1, 2026. However, providers who had a site visit scheduled in advance of the Oct. 1, 2026 policy change can expect the site visit to be conducted as scheduled.
Additionally, providers who have already completed a site visit through Medicare within the past five years should indicate such on their application. These providers will not need to complete another site visit at this time.
Links and Resources
- Provider Enrollment FAQs (reference question #6)
- NC Medicaid Bulletins
- Provider Announcements
Contact
- Call PCG at 1-877-522-1057 and select Option 1; or
- Email PCG at NC_Medicaid_Provider_Screening@pcgus.com