The Patient Protection and Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information roughly every five years.
- CMS has completed Cycle 1 Revalidation. There were three phases to Cycle 1 revalidation.
- The first phase was to get everyone into PECOS. This helped clean up the claims system.
- Phase two was making sure all organizations were revalidated.
- Phase three revalidated everyone else.
- Cycle 2 Revalidation began February 2016.
- This will start to establish the five year cycle.
- All actively enrolled providers/suppliers will be required to revalidate.
CMS has established due dates for Revalidation on the last day of the month (e.g. January 31, 2017, June 30, 2017).
Submit your revalidation application to your Medicare Administrator Contractor (MAC) within six months of your due date to avoid deactivation of your Medicare billing privileges.
There are several ways to determine when you are due for revalidation:
- The list will be available at Data.CMS.gov/revalidation and will include all enrolled providers/suppliers.
- Those due for revalidation will display a revalidation due date.
- Applications submitted before the six month revalidation time frame will be returned.
- All providers/suppliers not yet up for revalidation will display a "TBD" (To Be Determined) in the due date field.
- The list will be updated on a monthly basis. Noridian advises to check often.
- Each organization will receive their own revalidation request letter.
- Noridian will mail two revalidation letters. One to the special payments address and one to the correspondence address. If both of those addresses are the same, a letter will be mailed to the practice location.
Organizations listed on the website with a due date should submit their revalidation application. Do not wait for a letter. Organizations are required to revalidate within their six month window.
Revalidation Application Submission
Advantages of Submitting Via Internet-Based PECOS Web
Submitting your revalidation via Internet-based PECOS web is the preferred method. It has advantages that include:
- Faster application process
- Automatic selection of proper enrollment form(s)
- Fewer submission errors/omissions
PECOS allows you to securely review information currently on file, update and submit your revalidation via the Internet. Prior to submission, be sure to upload all required supporting documentation and electronically sign the certification statement.
To avoid any registration issues, review the PECOS related documents available on the CMS PECOS summary webpage.
Failure to Revalidate
Organizations who are not revalidated will be deactivated. Any revalidation application submitted after the deactivation will be subject to a lapse in coverage.
- Pend Status: Organizations will have their enrollment record placed into a pend status if a revalidation application isn't received by the Due Date. The pend status holds all paper checks, Standard Remittance Advices (SPRs), and Electronic Funds Transfer (EFT) from being issued until a revalidation application is received.
- Deactivation: The Organization is at risk when the revalidation application is received after the due date. The best way to avoid any lapse in coverage is to make sure the application is submitted prior to the due date listed on data.cms.gov. The deactivation of an Organization will cause no payment to be made. A lapse in coverage will occur from the date of Deactivation to when Noridian receives an application to reactivate the Enrollment. No payment will be made during those dates. A stop billing privileges letter will be sent and access to the Noridian Medicare Portal will be revoked.
- CMS Internet-based PECOS
- CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 15
- CMS Revalidation Information
- Electronic Code of Federal Regulations
Last Updated Jan 18, 2018