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Enroll/Make Changes via PECOS Web

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Revalidation

Overview

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.
  • Providers opted out of Medicare or enrolled solely to order, certify, and prescribe do not have to revalidate.

Revalidation Future

CMS has established due dates for Revalidation on the last day of the month (e.g. May 31st, 2016, June 30th, 2016).

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.

Revalidation Tools

There are several ways to determine when you are due for revalidation:

  • The list will be available at Data.CMS.gov/revalidation This link will take you to an external website. 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.
    • An option is available for organizations to view a list of all reassigning providers and their due dates.
    • Providers and suppliers who are enrolled in Medicare solely to order, certify and/or prescribe via the CMS-855O application or have opted out of Medicare, are not required to revalidate and will not appear on the lookup tool.
  • The list will be updated on a monthly basis. Noridian advises to check often.
  • Each provider will receive their own revalidation request letter.
    • We 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.
    • Revalidation notices for individual group members will list the organization or organizations with whom the individual provider reassign benefits.

Providers/Suppliers listed on the website with a due date should submit their revalidation application. Do not wait for a letter. Providers/Suppliers are required to revalidate within their six month window.

Revalidation Application Submission

The fastest and most efficient way to submit your revalidation information is via Internet-based PECOS Web This link will take you to an external website.. Applications can also be submitted via the paper CMS-855 forms, after watching the Enrollment on Demand for accurate 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 know what supporting documentation is needed, view our Enrollment on Demand Application Tutorials.

To avoid any registration issues, review the PECOS related documents available on the CMS PECOS summary webpage.

Failure to Revalidate

Group Members 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 provider or 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 for any members associated to the Organization. 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.

Tips

Group Member

  • Complete sections 1, 2, 3, 4b, 13, and 15 of CMS 855I, even if nothing has changed
  • Complete sections 1, 2, 2e, 13 and 15 of CMS 855I for Physician Assistants (PAs), even if nothing has changed
  • List all reassignments including other Organizations, Provider Transaction Access Numbers (PTANs) and National Provider Identifiers (NPIs) in which provider renders services
  • Attach all supporting documentation such as Diploma and Certification

Sole Owner

  • Complete sections 1, 2, 3, 4a-4c, 6, 8, 13, and 15 of CMS-855I, even if nothing has changed
  • Attach all supporting documentation such as Diploma, Internal Revenue Service (IRS) document, Certification, CMS-588 Electronic Funds Transfer (EFT) and voided check/bank letter
  • List all current, active practice locations
  • Use boxes/fields to indicate change, add, delete and list an effective date
  • Include a contracted or W-2 managing employee

Sole Proprietor

  • Complete sections 1, 2, 3, 4c, 6, 8, 13, and 15 of CMS-855I, even if nothing has changed
  • Attach all supporting documentation such as Diploma, IRS document (if billing with EIN), Certification, CMS-588 EFT, voided check/bank letter
  • List all reassignments, if applicable, including other Organizations, PTANs and NPIs in which provider renders services
  • List all current, active practice locations
  • Use boxes/fields to indicate change, add, delete and list an effective date
  • List all directors, board members, and contracted or W-2 managing employee

Organizations

  • Complete all sections of CMS-855B, even if nothing has changed
  • Attach all supporting documentation such as IRS document, CMS 588EFT, voided check/bank letter
  • List all current, active practice locations
  • Use boxes/fields to indicate change, add, delete and list an effective date

Resources

Last Updated May 09, 2017