May 10, 2016
Area(s) of Interest: Payor Contracting Practice Management
Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent fraud within the Medicare system. Once a Medicare enrollment application is validated, the clock starts ticking on a five-year revalidation cycle. Now that five years have passed since the ACA's revalidation requirement took effect, the Centers for Medicare and Medicaid Services (CMS) has initiated a second cycle of revalidation requests.
According to CMS, Medicare Administrative Contractors (MAC) – Noridian in California – will continue to send revalidation notices two or three months prior to each provider’s revalidation due date.
The first revalidation due date for this second cycle is May 31, 2016. If you received a revalidation notice, and a complete application is not received by the due date, your Medicare billing privileges will be deactivated.
If you do not know if you received a notice, you can look up your revalidation date through the CMS look-up tool. Those 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.
If you are deactivated for failure to respond to a revalidation notice, you must submit a reactivation application. The date of receipt of the reactivation application will be the new effective date for Medicare billing privileges. No payments will be made for the period of deactivation.
What providers need to know:
- If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with each entity.
- MACs will send revalidation notices (either by email or mail) two or three months prior to the revalidation due date. When responding to revalidation requests, be sure to revalidate your entire Medicare enrollment record, including all reassignment and practice locations.
- If a revalidation application is received but incomplete, your MAC will contact you for the missing information. If the missing information is not received within 30 days of the request, the MAC will deactivate your billing privileges.
- If billing privileges are deactivated, a reactivation will result in the same Provider Transaction Access Number, but there will be an interruption in billing during the period of deactivation. This will result in a gap in the provider’s enrollment status with Medicare.
- If the revalidation application is approved, 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.