How to Handle a Revalidation Request from Medicare

Posted by KUNAL JAIN on Dec 9 2014

Fotolia_10588749_Subscription_Monthly_MSection 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under the 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 not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation 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.

Were you sent a revalidation request from Medicare?

Available in the “Downloads” section is a listing of the providers and suppliers who have been selected to revalidate and should be receiving a revalidation notice from their Medicare contractor within the next 60 days. This list will be updated periodically after new revalidation lists are provided to the MACs. This is informational only. Providers and suppliers should not take any action to revalidate until they are asked by their Medicare contractor to do so. Also available in the "Downloads" section, is a listing of all providers and suppliers who have received a revalidation notice in the mail. The files are broken down by the month in which the revalidation request was sent. CMS will add lists on a bi-monthly basis. If you are listed, and have not received the request, please contact your Medicare contractor. Their contact information can also be found in the "Downloads" section.

How would you handle it?

First and foremost, you need to acquire your own NPI username and password from your billing personal or company. If you don’t have access to this information, physicians should call NPI Enumerator at the following number: 1-800- 465-3203. You will give them your personal information or go to their website to reset your username or password.

Once you have this information, you need to go to the PECOS website and enter the same information and check the enrollment status of your Medicare application. If it shows that a revalidation notice has been sent, then you need to create an application to revalidate your information in the Medicare system. You can also access your group, as well as your own individual, Medicare records from here.

Remember, it is very important that you do this process online only. You can add and edit all of the information about your practice in real time, upload the necessary documents, and sign the application electronically. Once you have electronically signed it, you don’t need to send any documents or a paper application. Once your application gets accepted electronically, you are good to go.

Tips to fill documents:

  • Bank EFT Information is mandatory for Medicare revalidations therefor call your bank and get the phone and address with bank managers name. This information goes through PECOS.

  • Voided check is scanned and uploaded into the Medicare system so keep that handy.

  • If you are an Immigrant your ID license or passport gets scanned into the system.

Questions concerning provider enrollment policy or your provider's situation should be referred to your MAC. Their contact information can be found in the "Downloads" section. Questions concerning a system issue regarding PECOS should be referred to the CMS EUS Help Desk at 1-866-484-8049, or send an e-mail to EUSSupport@cgi.com.

 

Request a Consultation

Topics: Medicare, Revalidation Request

Subscribe to Email Updates

Posts by Topic

see all
7-advantages-outsourcing-medical-billling