The Revalidation of Provider Enrollment Information

The revalidation process is a requirement of the Affordable Care Act for all Medicare providers and suppliers to revalidate their enrollment information in the Medicare program under new enrollment screening criteria.  The revalidation process affects only those Medicare providers who submitted their initial applications prior to March 25, 2011.  (Revalidation won’t affect providers who submitted their applications on or after March 25, 2011.)

CMS has extended the revalidation period for another two years which means the notices will be sent on a regular basis through March of 2015.  When you receive your revalidation notice, you must respond either through internet-based PECOS, which is the most efficient way, or by completing the appropriate CMS 855 application form.  The first set of revalidation letters were sent to Medicare providers who are actively billing and who were not listed in PECOS.  The letter is sent to the primary practice or special payment address if the provider is not listed in PECOS.  If the provider is found in PECOS, the letter is sent to the special payments and correspondence addresses simultaneously.  If those addresses are the same, CMS sends one to the primary practice address as well.

For those providers who are not listed in PECOS and have not received a revalidation letter, we suggest that you contact your Medicare contractor.  If you are an institutional provider and deemed by CMS to pay a fee for your revalidation, you can submit your fee by ACH debit or credit card.  The revalidation won’t be processed until payment has been made.  Don’t forget to submit the Certification Statement along with your receipt of payment.

The revalidation process does not change other aspects of the enrollment process; providers should continue to submit their routine changes (address updates, reassignments, additional practice locations, etc.) in the usual manner.  If you have a routine change and also have received a revalidation letter, transact them separately.

Providers and suppliers who fail to submit enrollment forms 60 days from the date of the revalidation letter may experience a deactivation of their Medicare billing privileges.

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