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Noridian begins next round of Medicare revalidation process

April 23, 2014
Area(s) of Interest: Advocacy Health Care Reform Payor Issues and Reimbursement 

As called for under the Affordable Care Act (ACA), Medicare Administrative Contractors (MACs) have been requiring physicians to revalidate their Medicare enrollments. Between now and March 23, 2015, MACs will continue reaching out to physicians on a regular basis, notifying them if they need to revalidate. Noridian, California's MAC, recently sent another round of revalidation letters. This revalidation effort applies to providers and suppliers that were enrolled prior to March 25, 2011.


The revalidation requirement is necessitated by new screening criteria called for under the ACA. Newly enrolling and revalidating providers will be placed in one of three screening categories representing the level of risk to the Medicare program. The level of risk will determine the degree of screening to be performed when processing the enrollment application.


Physicians who receive a request for revalidation must respond to that request within 60 days or face the possibility of being deactivated. Do not do anything until you get a letter instructing you to revalidate. (This is very important to ensure an orderly enrollment process.) Physicians who are making changes (moving, closing practice, etc.) should continue to submit their changes as usual.


A change of procedure in this and future rounds of revalidation requests is a requirement to submit an Electronic Funds Transfer form (CMS 588), even if you are already receiving funds electronically from Medicare.


The Centers for Medicare and Medicaid Services (CMS) publishes a list of providers who have been sent revalidation requests, broken down by the month in which the revalidation request was mailed. CMS will add lists on a bimonthly basis. If you are listed, and have not received the request, please contact Noridian at (855) 609-9960.

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