September 20, 2017
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement
Noridian, Medicare’s administrative contractor for California, has reported that of the 19,701 providers who were requested to revalidate from May 31, 2016, to January 31, 2017, only 14,553 responded to the revalidation request prior to their designated deadline. The remaining 5,148 providers therefore had their Medicare billing privileges deactivated.
What providers need to know:
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, Noridian will send a paper revalidation notice to the correspondence, special payments and/or primary practice address on file.
When responding to revalidation requests, it’s important to revalidate your entire Medicare enrollment record, including all reassignment and practice locations.
- 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 for the missing information. If the missing information is not received within 30 days of the request, Noridian will deactivate your 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 gap in the provider’s enrollment status 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.
Providers can now look up an individual provider or organization to identify the revalidation date through CMS’ look-up tool. 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.
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.