Revalidation - JF Part A
Revalidation
The Patient Protection and Affordable Care Act requires all enrolled providers to revalidate their Medicare enrollment information roughly every five years. Revalidation is the process of confirming that the information Medicare has on file is correct. Additional details are available in the CMS Internet Only Manual (IOM), Publication 100-08, Chapter 10, Section 10.1.2
All actively enrolled providers will be required to revalidate.
Due Dates
CMS assigns revalidation due dates as the last day of the assigned month (for example, January 31 or April 30). To avoid deactivation of Medicare billing privileges, providers must submit their revalidation application to the appropriate Medicare Administrative Contractor (MAC) within seven months of the due date. Applications submitted earlier than this seven‑month window are returned as unsolicited. If a provider submits an application during this time that only updates or changes Medicare enrollment information, those updates may be processed, but the submission will not count as a revalidation. In that situation, the provider must submit a separate revalidation application within the required seven‑month time frame to maintain active enrollment.
Look-up Tool
The Medicare Revalidation List Look-up Tool is an online resource that allows providers to check whether their Medicare enrollment must be revalidated. The list displays all enrolled providers, and if a provider is due for revalidation, a specific revalidation due date will be listed. Providers who are not yet required to revalidate will see "TBD" (To Be Determined) in the due date field. When searching by NPI, enter the number without a trailing space, as an extra space can cause inaccurate results; if there is no extra space and no due date is shown, revalidation is not required at that time. Even after a revalidation application is submitted (or while it is still being processed), the due date may continue to appear on the website. Once the application is processed and notification letters are issued, the provider will not need to revalidate again until CMS requests it. The list is updated every 60 days, so providers who see a due date should submit the revalidation application within the seven‑month window and should not wait to receive a letter.
Notification
Each provider receives a separate revalidation request letter from Medicare. Noridian mails two revalidation letters for each provider: one to the special payments address and one to the correspondence address on file. If both of those addresses are the same, the letter is mailed to one of the practice locations. In addition to mailed letters, Noridian sends reminder emails. An initial reminder email is sent approximately four months before the revalidation due date, and if a valid correspondence email address is on file, a second reminder is sent about one and a half months before the due date. These reminder emails are generic notices stating that the enrollment is due for revalidation and do not include any identifying or personal information.
Failure to Revalidate
Stay of Enrollment
A stay of enrollment, often called a "stay," is a temporary pause placed on a Medicare enrollment when certain requirements are not met. During a stay, you remain enrolled in Medicare, but any claims submitted with dates of service that fall within the stay period will be rejected. A stay can last up to 60 days, although it may be imposed for a shorter period. The stay ends as soon as Medicare or its contractor determines that you have returned to compliance with all enrollment requirements, or automatically on the day after the stay period expires, whichever comes first. A stay is not considered an adverse legal action, and Medicare may impose multiple stays in the future if there are separate instances of non‑compliance, such as one stay occurring in June 2026 and another in December 2026.
Deactivation
Enrollment is considered at risk if a revalidation application is received after the assigned due date. If a provider does not submit any revalidation application at all, Medicare will deactivate the enrollment, typically within 60 to 75 days after the due date.
Reactivation
Reactivation means that you must re-enroll in Medicare before your enrollment can become active again. When a reactivation application is submitted, Noridian processes it as if it were a new enrollment. If supporting documentation is already on file from a previous enrollment, you do not need to submit it again. However, the application must be fully completed and approved for your Medicare enrollment to be reinstated as active.
Application Submission
The most efficient way to submit information is through the internet‑based PECOS. If preferred, applications may also be submitted using the paper CMS‑855 form(s).
