Revenue Cycle Management Blog | GroupOne Health Source

Do Not Ignore Medicare's Revalidation Process!

Written by Kaitlyn Houseman | January 31, 2013

Have you received your Medicare Revalidation Letter Yet?

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are generally not impacted.

CMS has reevaluated the revalidation requirement in the Affordable Care Act, and believes it affords the flexibility to extend the revalidation period for another 2 years. This will allow for a smoother process for providers and contractors. Revalidation notices will now be sent through March of 2015.

IMPORTANT: This does not affect those providers which have already received a revalidation notice. If you have received a revalidation notice from your contractor respond to the request by completing the application either through internet-based PECOS or by completing the appropriate 855 application form.

Therefore, between now and 2015, MACs will send out revalidation notices on an intermittent, but regular basis to begin the revalidation process for each - provider and supplier. Providers and suppliers must submit the revalidation application only after being asked by their MAC to do so. Please note that 42 CFR 424.515(d) provides CMS the authority to conduct these off-cycle revalidations.

The first set of revalidation notices went to providers who are billing, but are not currently in PECOS. To identify these providers, contractors searched their local systems and if a Provider Transaction Access Number (PTAN) for a physician was not in PECOS, a revalidation request for that physician was sent.  CMS asks all providers who receive a request for revalidation to respond to that request.

• For providers NOT in PECOS – the revalidation letter will be sent to the special payments or primary practice address because CMS does not have a correspondence address. 

• For providers in PECOS – the revalidation letter will be sent to the special payments and correspondence addresses simultaneously. If these are the same, it will also be mailed to the primary practice address. If you believe you are not in PECOS and have not yet received a revalidation letter, contact your Medicare contractor. Contact information may be found at here on the CMS website

To access PECOS, your Authorized Official must register with the PECOS Identification and Authentication system. To register for the first time, click here to create an account

Failure to respond to revalidation requests within the time frame specified in the letter (30-60 days), will result in deactivation of billing privileges. If deactivation occurs, providers will have to reenroll in Medicare.

With the exception of physicians, non-physicians practitioners, physician group practices and non-group practices, providers and suppliers that are revalidating their enrollment information must submit with their application an application fee in the amount of $505 and/or a request for a hardship exception to the application fee. Submit the enrollment fee via Pay.Gov prior to submitting the application (reference 42 CFR 424.514). The fee for all revalidations received in calendar year 2011 is $505. You can submit your fee by electronic check, debit or credit card only. If you feel you qualify for a hardship exception waiver, submit a letter and financial statements to request a waiver in lieu of the enrollment fee along with your application or certification statement. Revalidations are processed only when fees have cleared or the hardship waiver has been granted. You will be notified by mail if your waiver request has been granted or if a fee is required.