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Revalidation of Medicare Enrollment

All providers who 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 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 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 to providers who did not have complete information in the Provider Enrollment, Chain & Ownership System (PECOS). Revalidation mailings have been sent to the remaining providers subject to revalidation and will continue to be sent on an ongoing basis until March 2015. The names and National Provider Numbers of the providers who have been sent revalidation notices are listed, by mailing date, in the Downloads section of the Centers for Medicare & Medicaid Services' Revalidations websiteExternal Link.

Revalidation notices are 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 or the paper application process with applications downloaded from the CMS website.

Required Documents:

  • Copies of diplomas and/or academic transcripts, certifications, and any other documents needed to establish that non-physician practitioners meet Medicare's eligibility requirements for their specialty.
  • A CP-575 or other form issued by the Internal Revenue Service to document the legal business name and employer identification number (EIN) of organizations.
  • 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; if the CMS-588 form on file with Medicare is not the current, 2010 version of the form; 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.
  • Other documents may also be required on a case-by-case basis, e.g., a copy of the provider's driver's license for signature verification purposes.

Application Fee:

With the exception of physician group practices and non-physician practitioner group practices, organizations submitting a CMS-855B 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. For Calendar Year 2013, the application fee is $532.00. Providers submitting paper applications should pay the application fee prior to submitting the application via the CMS website. 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:

The mailing addresses to which paper applications, and certification statements and required documents for Internet-based PECOS applications, should be sent are:

Overnight Delivery Mailing Address
Wisconsin Physicians Service
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
 
Wisconsin Physicians Service
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248


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

  • The CMS-855O form cannot be used for revalidation. This form is used only by physicians and practitioners who enroll in Medicare for the sole purpose of being the ordering/referring provider on Medicare claims. The revalidation requirement does not apply to these providers.
  • The revalidation requirement does not apply to physicians and practitioners who have opted out of Medicare.
  • "You are revalidating your Medicare enrollment" should be checked as the Reason for Application in Section 1A of the CMS-855I or CMS-855B enrollment form.
  • Physicians and nonphysician practitioners who reassign their Medicare benefits to a group practice or organization must submit both a CMS-855I and CMS-855R to revalidate their Medicare enrollment.
  • One CMS-855I and CMS-855R may be submitted to revalidate all PTANs for reassignment to the same legal business entity (tax identification number). A separate revalidation application form(s) should be submitted to revalidate PTANs associated with each legal business entity.
  • 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, if the provider (other than those reassigning their benefits) is not already receiving Medicare benefits electronically; if the CMS-588 form on file with Medicare is not the current, 2010 version of the form; or if the provider is making a change to existing EFT arrangements.
  • A CMS-460 Medicare Participating Physician or Supplier Agreement should not be submitted; the revalidation process does not affect the current participation status of providers.
  • Providers who receive notification to revalidate a PTAN for a practice at which they are no longer active should submit the appropriate CMS-855 as a change of information to notify us of the termination.

Additional References

Centers for Medicare & Medicaid Services (CMS) - Revalidations
MLN Matters MM7350, "Implementation of Provider Enrollment Provisions in CMS-6028-FC"
MLN Matters SE1126, "Further Details on the Revalidation of Provider Enrollment Information"
MLN Matters SE1130, "Implementation of Pay.gov Application Fee Collection Process through PECOS"
Sample WPS Revalidation Letter

Page Last Updated: Monday, 29-Sep-2014 14:11:26 CDT