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," SE1605 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/revalidation 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/revalidation.
- Submit the revalidation application through Internet-based PECOS, the fastest and most efficient way to submit your revalidation information.
- Complete the appropriate CMS-855 application. Applications are available on the "Enrollment Applications" 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, 2016Services provided to Medicare patients from November 15, 2016, through December 30, 2016, will not be paid and are the provider's liability.
- Refer to the CGS checklist for your appropriate provider type to ensure the enrollment application is complete.
- 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.
- The fee may be submitted by ACH debit, or credit card. To pay your application fee, go to https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do and submit payment as directed.
Resources:
- "Provider Enrollment Revalidation – Cycle 2" SE1605 MLN article
- Revalidations – CMS website
- CMS Lookup Tool
- Provider Enrollment, Chain and Ownership System (PECOS)
- CGS Provider Enrollment Revalidation Web pages:
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