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Revalidation of Medicare Enrollment

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles in accordance with 42 CFR §424.515.

Providers can use the resource links listed here to obtain specific information related to Provider Enrollment Revalidations - Cycle 2

Revalidation Resources

CMS Revalidations web page

Revalidation Due Date List

MLN Matters SE1605, Provider Enrollment Revalidation - Cycle 2

Internet Based PECOS

Revalidation Checklist

Established Due Dates for Revalidation

CMS has established due dates by which the provider/supplier's revalidation application must reach their MAC in order for them to remain in compliance with Medicare's provider enrollment requirements. The due dates will generally be on the last day of a month (for example, June 30, July 31 or August 31). Submit your revalidation application to your MAC within 6 months of your due date to avoid a hold on your Medicare payments and possible deactivation of your Medicare billing privileges. Generally, this due date will remain with the provider/supplier throughout subsequent revalidation cycles.

Unsolicited Revalidation Submissions

All unsolicited revalidation applications submitted more than 6 months in advance of the provider/supplier's due date will be returned.

If your intention is to submit a change to your provider enrollment record, you must submit a change of information application using the appropriate CMS-855 form.

Submitting Your Revalidation Application

Important: Each provider/supplier is required to revalidate their entire Medicare enrollment record.

A provider/supplier's enrollment record includes information such as the provider's individual practice locations and every group that benefits are reassigned (that is, the group submits claims and receives payments directly for services provided).This means the provider/supplier is recertifying and revalidating all of the information in the enrollment record, including all assigned National Provider Identifiers (NPIs) and Provider Transaction Access Numbers (PTANs).

If you are an individual who reassigns benefits to more than one group or entity, you must include all organizations to which you reassign your benefits on one revalidation application. If you have someone else completing your revalidation application for you, encourage coordination with all entities to which you reassign benefits to ensure your reassignments remain intact.

Deactivations Due to Non-Response to Revalidation or Development Requests

It is important that you submit a complete revalidation application by your requested due date and you respond to all development requests from your MAC timely. Failure to submit a complete revalidation application or respond timely to development requests will result in possible deactivation of your Medicare enrollment.

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:

Institutional providers of medical or other items or services and suppliers are required to submit an application fee for revalidations. The application fee is $554.00 for Calendar Year (CY) 2016. CMS has defined "institutional provider" to mean any provider or supplier that submits an application via PECOS or a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S forms.

All institutional providers (that is, all providers except physicians, non-physicians practitioners, physician group practices and non-physician practitioner group practices) and suppliers who respond to a revalidation request must submit the 2016 enrollment fee (reference 42 CFR 424.514) with their revalidation application. You may submit your fee by Automated Clearing House (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. A confirmation screen will display indicating that payment was successfully made. This confirmation screen is your receipt and you should print it for your records. CMS strongly recommends that you include this receipt with your uploaded documents on PECOS or mail it to the MAC along with the Certification Statement for the enrollment application. CMS will notify the MAC that the application fee has been paid. Revalidations are processed only when fees have cleared.

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
WPS GHA
Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
 
WPS GHA
Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248