Revalidation - JF Part A
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. Revalidation is the process of reviewing all information that is on file with Medicare is correct. All information can be found in CMS Internet Only Manual (IOM), Publication 100-08, Chapter 10, Section 10.1.2
CMS has completed Cycle 1 Revalidation.
- Phase 1 was to get everyone into PECOS. This helped clean up the claims system.
- Phase 2 was making sure all organizations were revalidated.
- Phase 3 revalidated everyone else.
Cycle 2 Revalidation began February 2016 which will start to establish the five-year cycle. All actively enrolled suppliers will be required to revalidate.
View the below information on this page.
- CMS has established due dates for Revalidation on last day of month (e.g. May 31, 2021, June 30, 2021)
- To avoid deactivation of Medicare billing privileges, submit revalidation application to appropriate Medicare Administrator Contractor (MAC) within seven months of due date
- If an application is submitted before seven months, it will be returned as unsolicited
- If application changes any of Medicare information, changes will occur but will not revalidate the enrollment. Another application must be submitted within seven months of due date
The Revalidation Look-up Tool is an online tool that can be used to verify if an enrollment must revalidate.
- View Medicare Revalidation List which includes all enrolled suppliers
- Those due for revalidation will display a revalidation due date
- All suppliers not yet up for revalidation will display a "TBD" (To Be Determined) in due date field
- If nothing is showing when and NPI is viewed, be sure there is not a space after the NPI. This will cause inaccurate information to display. If there is no space at end of NPI, and no due date populates, enrollment is not requested to revalidate at this time
- If enrollment has revalidated successfully, or application is still in processing, due date will still populate on website
- Once application has been completed, and notification letters have been sent, enrollment will not need to be revalidated again until requested
- List will be updated every 60 days
- Suppliers listed on website, with a due date, should submit their revalidation application. Do not wait for a letter. Providers/Suppliers are required to revalidate within their seven-month window
- View the How to Use the Revalidation Due Date Lookup Tool Enrollment on Demand (EoD) to learn how to use the Revalidation Look up Tool on the CMS website
- Each supplier will receive their own revalidation request letter
- We will mail two revalidation letters. One to special payments address and one to correspondence address. If both of those addresses are same, a letter will be mailed to one of the practice locations
- Reminder Emails
- Noridian will also send out a reminder email roughly four months before due date. If correspondence email address is valid, another email will be sent a month and a half before due date again. This will be a generic email stating that your enrollment is due for revalidation. It will not contain any identifying information within it
Failure to Revalidate
- Suppliers will have their enrollment record placed into a pend status if a revalidation application isn't received by due date. Pend will be placed on the enrollment up to 25 days after due date
- This means that it can be applied anywhere from 1-25 days after due date
- Pend status holds all Electronic Funds Transfers (EFTs) from being issued until a revalidation application is received
- Enrollment is at risk when revalidation application is received after due date
- If no application has been submitted, enrollment is deactivated 60-75 days after due date
- What does reactivation mean for you? It means that you must re-enroll with Medicare. Noridian will process the application as if it were a new enrollment
- If supporting documentation currently exists in supplier's file, supplier is not required to submit that documentation again during enrollment process
- Application must be fully completed for enrollment to be active in Medicare
The fastest and most efficient way to submit revalidation information is via Internet-based PECOS Web. Applications can also be submitted via the paper CMS-855A form.
Last Updated Fri, 15 Oct 2021 17:20:13 +0000