Reminder: Failure to Revalidate Medicare Enrollment Information Could Result in Deactivation

 

Providers are reminded that Noridian, California’s Medicare Administrative Contractor, is continuing to send revalidation notices to providers who are required to revalidate their Medicare enrollment information.

Since the passage of the Affordable Care Act (ACA), in an effort to prevent fraud, all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria. 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) is continuing its second cycle of revalidation requests.

What providers need to know:

  • If you have multiple reassignments/billing structures, you must coordinate the revalidation application submission with each entity.
  • 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 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.

 

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