Provider Enrollment Revalidations: Things You Should Know
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May 23, 2016 - Revised: 12.19.17

Provider Enrollment Revalidations: Things You Should Know

The Centers for Medicare & Medicaid Services (CMS) issued MLN Matters® article, "Provider Enrollment Revalidation – Cycle 2," SE1605External PDF informing providers that the initial round of revalidations has been completed and CMS has resumed regular revalidations cycles. To reduce provider/supplier burden, CMS has implemented revalidation process improvements. The following provides things you should know about the cycle 2 revalidation process.

  • CMS has established revalidation due dates. Revalidation due dates can be found on the lookup tool at https://data.cms.gov/revalidationExternal Website on the CMS website.
    • Due dates not yet assigned will indicate "TBD" (to be determined).
    • Due dates will be posted monthly to have at least 6 months available. CGS encourages providers to check this at least each month.
    • Due dates are listed up to 6 months in advance.
    • Revalidations are due the last day of the month.
    • DO NOT submit an enrollment revalidation more than six months in advance of the due date. If you submit a revalidation application, and your due date is listed as "TBD" the application will be returned.
  • CGS will issue revalidation notices in addition to the CMS lookup tool. Notices will be mailed 2-3 months before the established due date. Your office personnel should be aware that the notice will be sent in a yellow envelope.
  • If you are within 2 months of the listed due date and have not received a notice from CGS, you are encouraged to proceed with submitting your revalidation application by the due date indicated in the CMS lookup tool at https://data.cms.gov/revalidationExternal Website.
  • Submit the revalidation application through Internet-based PECOSExternal Website, the fastest and most efficient way to submit your revalidation information.
  • Complete the appropriate CMS-855 application. Applications are available on the "Enrollment ApplicationsExternal PDF" page on the CMS website.
  • If a revalidation application is received but is incomplete, CGS will develop for the missing information. Respond timely to all development requests from CGS to avoid a hold on your Medicare payments and possible deactivation of Medicare billing privileges.

    NOTE: If your enrollment is deactivated, you will be required to submit a new full and complete application to reactivate your enrollment and billing privileges.

    • For Part A, Part B certified (Ambulatory Surgery Centers (ASCs) and Portable X-Ray Suppliers), home health, and hospice providers, once the full enrollment application is received, your enrollment will be reactivated with your original effective date. Any claims for services provided during the deactivation period will need to be submitted for processing.
    • For Part B non-certified providers, once the full enrollment application is received, your new provider effective date will be the date CGS received the new full and complete application. This new effective date will not change. Therefore, any services provided during the period between deactivation and reactivation, will not be paid by Medicare; therefore, this will cause a gap in reimbursement for your facility.

    For example:
    Revalidation Due date – September 30, 2016
    Revalidation Received – October 30, 2016
    Deactivated – November 15, 2016
    New full enrollment application received – December 30, 2016
    New provider enrollment effective date – December 31, 2016

    Services provided to Medicare patients from November 15, 2016, through December 30, 2016, will not be paid and are the provider's liability.

  • Institutional providers are required to submit a fee. An institutional provider is defined as a provider or supplier submitting an application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S forms.

Resources:

Please share this information with your appropriate staff to ensure a successful provider revalidation process for your facility. If you have questions, please contact the CGS Provider Enrollment staff by calling the appropriate telephone number below for your provider type.

  • Home Health & Hospice - 1.877.299.4500, select option 3
  • Part A - 1.866.590.6703, select option 3
  • Part B – 1.866.276.9558, select option 3

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