September 06, 2017
Area(s) of Interest: Commercial Payors Practice Management Payor Issues and Reimbursement
Noridian, Medicare’s administrative contractor for California, has seen a spike in the number of providers deactivated for not responding to Medicare revalidation notices, resulting in a gap in billing privileges and lost revenue for physicians.
Noridian will send revalidation notices via email two or three months prior to the revalidation due date. Revalidation notices sent via email will indicate "URGENT: Medicare Provider Enrollment Revalidation Request" in the subject line to differentiate from other emails. If the email is returned as undeliverable, only then will Noridian will send a paper revalidation notice to the correspondence, special payments and/or primary practice address on file.
Physicians don’t, however, have to wait for a revalidation letter. CMS has a look-up tool that allows a practice to look up an individual physician’s or organization’s revalidation date. Providers due for revalidation in the near future will display a revalidation due date. All other providers/suppliers will see "TBD" in the due date field.
What physicians need to know:When responding to revalidation requests, it’s important to revalidate your entire Medicare enrollment record, including all reassignment and practice locations through internet-based PECOS or via the CMS 855 form.If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with each entity.If a revalidation application is received but incomplete, Noridian will contact you via email for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your billing privileges.Do not assume that “no news is good news.” The contact person indicated on the application should receive an email notice of the application receipt, any discrepancies, and either a stop billing privileges or acknowledgement letter of approval. Check your spam filter if you’re not receiving these notices.Failure to revalidate may result in a deactivation of your Medicare billing privileges.If billing privileges are deactivated, a provider request to reactivate will result in the same Provider Transaction Access Number, but there will be a lapse in coverage with Medicare. The provider will be required to submit a new full and complete application in order to reestablish the enrollment record and related Medicare billing privileges.If the revalidation application is approved, the provider will receive email confirmation that the provider will be revalidated and no further action is needed.For more information on the revalidation process, see MLN Matters #SE1605.
If you have questions about the revalidation process, click here or contact Noridian by calling (855) 609-9960.