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Revalidations

CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements.

For more information see MLN Matters® Number: SE1605 or review the March, 2016 Revalidation Cycle 2 MLN Connects Call.

Why must I revalidate?
Section 6401 (a) of the Affordable Care Act:

  • Established new screening requirements for new and existing providers/suppliers
  • Required all existing providers/suppliers to be revalidated under new screening requirements
  • Reinforces the revalidation requirements at 42 CFR §424.515

When Must I revalidate?
Revalidations are due on the last day of the month (i.e.: June 30, 2016, July 31, 2016, August 30, 2016). You are expected to submit your revalidation application by this date.  Generally, this due date will remain with you throughout subsequent revalidation cycles.
Due Dates are posted on
Data.CMS.gov/revalidation - lists all currently enrolled providers/suppliers and their revalidation due date

  • Due Dates are updated every 60 days at the beginning of the month
  • Due Dates are listed up to 6 months in advance
  • Due Dates that are not yet assigned will be listed as TBD – To Be Determined (more than 6 months until your due date)
  • Durable Medical Equipment Prosthetic and Orthotic Supplies (DMEPOS) suppliers will not display a due date; instead, DMEPOS suppliers will receive communication from the National Supplier Clearinghouse (NSC) identifying when their revalidations are due
  • Search by individual provider or organization
  • See providers reassigned to your group and when they are due to revalidate
  • Download the entire revalidation data set in different formats (i.e., CSV, PDF, XLS, XLSX or XML)


Revalidation Notices sent via email/mail

  • Your Medicare Administrative Contractor (MAC) will send a revalidation notice within 2-3 months prior to your revalidation due date
  • Will identify organizations to which individual providers reassign benefits
  • Sent to email addresses reported on your prior applications, or
  • Sent via postal mail to at least two of your reported addresses (Sample A/B MAC Letter and DMEPOS Letter)
    • Correspondence address
    • Special Payments address and/or
    • Your primary practice address

NOTE:  If you are within 2 months of the listed due date on Data.CMS.gov/revalidation but have not received a notice from their MAC to revalidate, you are encouraged to submit your revalidation application.
 

Do not submit a revalidation if:

  • You have not received an email/mailed letter from your MAC requesting you to revalidate (request from NSC for DMEPOS suppliers)
  • Due date is not listed on data.CMS.gov/revalidation
  • These unsolicited revalidations will be returned

NOTE: If your intention is to submit a change to your provider enrollment record, Submit a ‘change of information’ application using Internet Based PECOS or the appropriate CMS-855 form.

How do I revalidate?
Revalidate your entire enrollment record, including:

The most efficient way to submit your revalidation information is via Internet Based PECOS. You can:  

  • Review information currently on file
  • Update and submit your revalidation
  • Electronically sign after uploading supporting documents; or print, sign, date and mail your paper certification along with supporting documentation

What happens if I don’t revalidate?
Submit a complete revalidation application by your due date, and respond on time to all related requests from your MAC to avoid:

  • Possible hold on your Medicare payment
  • Deactivation of your Medicare billing privileges

Deactivated providers will be required to submit a complete application to reactivate their enrollment

  • Will maintain their original PTAN
  • Reactivation date will be date of receipt of new complete application
  • No payments will be made for the period of deactivation

Still have questions? Please view the Revalidation FAQs
Questions regarding your enrollment?
Contact Your MAC