Departments

Revalidation of Medicare Enrollment

All providers that were enrolled with Medicare prior to March 25, 2011, will be required to revalidate their Medicare enrollment by submitting the appropriate CMS-855 Medicare enrollment form(s) to their Medicare contractor in response to notices being sent between September, 2011, and March, 2015. This requirement for revalidation is based on Section 6401 of the Patient Protection and Affordable Care Act., which also requires that all providers be reevaluated under the new screening guidelines established in Section 6028 of the law. Providers have 60 days from the date of the revalidation notice to submit their complete enrollment information.

Providers are to submit their CMS-855 revalidation enrollment applications only after receiving notification that they are required to do so. Wisconsin Physicians Service is sending these notification letters on a regular, intermittent basis.

The initial, Phase 1, revalidation notices were sent in September 2011 to hospitals that do not have complete information in the Provider Enrollment, Chain & Ownership System (PECOS). Additional revalidation notices were sent to home health agencies (HHA's) in December, 2011. Revalidation mailings are being sent to the remaining providers subject to revalidation on an ongoing basis until March, 2015.

For providers who do not have complete information in PECOS, revalidation notices were sent to the provider's special payments address. For providers who do have complete information in PECOS, revalidation notices are being mailed simultaneously to the provider's primary special payments address and correspondence address. Providers must submit revalidation applications for all provider transaction access numbers (PTANs) reported on the revalidation notice.

Revalidation Applications

Providers can revalidate their CMS-855 Medicare enrollment applications via Internet-based PECOS(external link) or the paper application process with applications downloaded from the CMS website(external link).

Required Documents:

Copies of licenses, certifications, and any other documents needed to meet Medicare's eligibility requirement.
A CP-575 or other form issued by the Internal Revenue Service to document the provider's legal business name and employer identification number (EIN).
A CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement, if the provider (other than those reassigning their benefits) is not already receiving Medicare benefits electronically, or if the provider is making a change to existing EFT arrangements.
Documents relating to adverse legal actions reported in Section 3 of the application.
Copies of other documents, if applicable, as specified in Section 17 or elsewhere on the CMS-855 form.

Application Fee:

Organizations submitting a CMS-855A to revalidate their enrollment information must submit documentation of payment of the application fee and/or a request for a hardship exception to the application fee with the 855A. For Calendar Year 2012, the application fee is $523.00. Providers submitting paper applications should pay the application fee prior to submitting the application via the CMS website(external link). It can be paid by electronic check, debit card, or credit card. Providers submitting Internet-based PECOS applications will be prompted to pay the fee during the application process.

Hardship Exception Request

Providers may submit a letter and financial statements to request a hardship exception in lieu of the application fee along with their application or certification statement. Revalidations are processed only when fees have cleared or the hardship exception has been granted. Providers are notified by mail if their hardship exception request has been granted or if a fee is required.

Mailing Address:

Paper applications, and certification statements and required documents for Internet-based PECOS applications, should be mailed to:

Medicare Part A MAC J5 and Legacy Provider Enrollment Department
P.O. Box 1604
Omaha, NE 68101

Priority Mailing Address:

Wisconsin Physicians Service
Medicare Provider Enrollment
3333 Farnam Street Suite 700
Omaha, NE 68131

Failure to Revalidate

Failure to submit complete enrollment application(s) and all supporting documentation within 60 calendar days of the postmark date of the revalidation notice letter may result in providers' Medicare billing privileges being deactivated.

Additional Information

"You are revalidating your Medicare enrollment" should be checked as the Reason for Application in Section 1A of the CMS-855A enrollment form.
The revalidation notification letter or a copy of it should be enclosed with the revalidation application or certification statement.
A CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement is required only if the provider is not already receiving Medicare payment via electronic funds transfer or if changes are being made to their existing EFT arrangements.
Providers who receive notification to revalidate a PTAN for a closed practice location should submit a CMS-855A enrollment form as a change of information to notify us of the termination of the Medicare PTAN.

Inquiries

Questions regarding revalidation may be directed to our Provider Enrollment Department by calling our toll-free telephone number between the hours of 8:00 a.m. and 4:00 p.m. (C.T.) Monday through Friday: 1-866-734-9444