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Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs

Enrollment - Revalidation

1. Why do I have to revalidate? I just recently sent an application.
In accordance with the Patient Protection and Affordable Care Act, Section 6401, we must reevaluate all new and existing providers / suppliers under the new screening guidelines in CMS-FC-6028. These new guidelines went into effect on March 25, 2011. Medicare requires all enrolled providers and suppliers to revalidate enrollment information every five years. To ensure compliance with these requirements, existing regulations at 42 CFR §424.515(d) provide that Centers for Medicare & Medicaid Services (CMS) is permitted to conduct off-cycle revalidations for certain program integrity purposes.
2. What does revalidation mean?
Revalidation is a confirmation (or validation) that Medicare has the most up-to-date information on file.
3. None of the information on my file has changed; will I still be required to submit a revalidation application?
Yes. A complete CMS-855I, CMS-855B or CMS-855A is required even if there has been no change to your information.
4. How do I pay the revalidation application fee if I am a Part A or Part B institutional provider?
For those providers who submit applications online via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), as you proceed through the process, if a fee is required, you will be prompted to submit your payment by credit card or ACH debit card.
Once your payment transaction is completed, you will automatically return to the PECOS website to complete the remaining part of your application. PECOS will track the collection transaction and will update the payment status, allowing your application to be processed.
For providers using the CMS-855 paper enrollment application, you will submit your application fee by accessing the Medicare Enrollment Application Fee Form.
At the conclusion of the collection process, you will receive a receipt indicating the status of your payment. Please print a copy for your records. We strongly recommend that you attach this receipt to the completed CMS-855 application submitted to your Medicare contractor.
Note: CMS defines ‘Institutional’ providers as any provider or supplier that submits a paper Medicare enrollment application using the Form CMS-855A or Form CMS-855B (not including physician and non-physician practitioner groups).
5. How do I submit a request for a hardship exception?
You must submit a letter, describing the hardship and why it justifies an exception, and include the letter with the application.
Also, submit with your exception request, comprehensive documentation (which may include, without limitation, historical cost reports, recent financial reports such as balance sheets and income statements, cash flow statements, tax returns, etc.).
If submitting a paper application, the hardship exception letter must accompany the application. If the application is submitted via PECOS, the hardship exception letter must be uploaded to the application or accompany the certification statement.
Hardship exception requests, submitted separately from the application, are not accepted.
6. How do I know if the hardship exception request has been approved?
CMS reviews hardship exceptions and renders a decision within 60 calendar days from the date of the receipt of the hardship exception request at Novitas Solutions. During this review period, application processing ceases. CMS will communicate its decision to the provider/supplier and Novitas via letter. If approved, processing commences. If denied, you must pay the fee online within 30 calendar days.
7. What happens if I do not pay the fee or submit a request for a hardship exception at the time I submit the revalidation application?
If you do not submit the fee at the time of submission, and you haven’t submitted a request for hardship exception request, you will have 30 days to pay the fee online.
You will not get another opportunity to request a hardship exception.
Failure to pay the fee within 30 days will result in deactivation of your billing privileges.
8. What if a physician/practitioner receives a revalidation letter for a reassignment that is no longer valid (i.e., the physician / practitioner is no longer associated with that particular group)?
The individual or the group should submit a CMS-855R application to terminate that particular reassignment.
9. How many revalidation letters are sent to each provider / supplier?
All Medicare Administrative Contractors (MACs) receive revalidation mailing lists from CMS on a regularly scheduled basis, which includes the provider transaction access number (PTAN) that resides within the affected provider's / supplier’s enrollment record in PECOS.
One revalidation letter, including all PTANs / CMS certification numbers (CCNs) identified by CMS, is sent to each affected provider/supplier. However, we will issue separate letters if a provider / supplier enrolls in more than one state in our jurisdiction, and is required to revalidate in each state. If this occurs, separate revalidation applications are required for each state in which you must revalidate.
If someone is completing the application on behalf of an individual provider, that person is strongly encouraged to coordinate with all groups / entities to ensure all reassignments remain intact.
10. I received a revalidation letter. How do I revalidate my Medicare file?
You will need to submit a complete CMS-855A, CMS-855B or CMS-855I application, depending on your provider / supplier type.
If you enrolled in more than one state in our jurisdiction, you are required to submit a separate application for each state.
completing section 1 of the CMS-855 application, be sure to mark ‘Revalidation’ as the reason for submission.
Provide ALL active PTANs / CCNs in one CMS-855 application for each state, even if they are not included in the revalidation notification letter. Do not submit a separate application for each PTAN. Please see below for additional information. 
CMS 855I application - Physician / Non physician practitioners; which includes:
Individuals
Sole proprietors
Sole owners of a corporation
Group members
CMS 855B application - Clinics / Group practices or other suppliers
CMS 855A application - Institutional providers / suppliers that use CCNs should submit separate CMS-855A applications for each CCN. The only time you can submit multiple CCNs on the same CMS-855A application is if you are a sub-unit of the provider.
Note: PTANs (Part B) and CCNs (Part A) are your Medicare Identification Numbers.
Please go to the Enrollment Forms page of our website to download the necessary CMS-855 application(s).
11. Am I required to submit a CMS-588 Electronic Funds Transfer (EFT) Authorization form with my revalidation application?
If you are currently receiving payment via EFT, no CMS-588 EFT Authorization Agreement form is required in conjunction with the revalidation application. However, if you are not currently receiving payment via EFT, you will be required to submit the EFT form with your revalidation application. We may also request the form if we determine that you do not have a recent version on file.
12. I did not receive a revalidation letter. Can I go ahead and submit the application now?
We encourage you to wait until you receive a request to revalidate. Waiting until you receive a request will ensure that revalidations are manageable and processed in a timely manner and in accordance with CMS guidelines. However, if you are within two months of the listed due date, and have not received your letter, we encourage you to move forward with submitting your revalidation application.
13. Can you tell me when my revalidation letter will be mailed?
We are unable to provide information as to which designated mailing a particular provider / supplier’s letter will be included.
Beginning March 1, 2016, a listing of all currently enrolled providers / suppliers will be available through the Medicare Revalidation Lookup Tool on the CMS website. Those due for revalidation will display a revalidation due date, all other providers/suppliers not up for revalidation will display a "TBD" (To Be Determined) in the due date field. The revalidation due date will be posted up to 6 months in advance to provide sufficient notice and time for the provider / supplier to comply.
14. Do I have to send a Medicare Participating Agreement (CMS-460) with my revalidation application?
No, the CMS-460 is not required.
15. How long after I receive my revalidation letter do I have to submit the revalidation application.
Your revalidation application is required by the revalidation due date listed in your revalidation letter. Failure to submit the requested revalidation application could result in deactivation of your Medicare billing privileges.
16. The Medicare Revalidation Lookup Tool on the CMS website lists my due date as "TBD". Can I submit my application now?
If you do not have an established due date (i.e., TBD), a revalidation application should not be submitted. We will return unsolicited revalidation applications.
17. Why am I having trouble processing a revalidation application on the Internet-based PECOS?
If you do not have an established record in PECOS, you will not be able to select ‘Revalidation’ as the reason for submission.
If you wish to use Internet-based PECOS to submit your revalidation application, you will have to select ‘New Enrollment’ and complete the application under this scenario. You can also complete the paper application, which does allow you to select ‘Revalidation’ as a submission reason.
Note: If you submitted a Medicare application since 2003, but you do not see your current enrollment information, please complete and submit a Security Consent Form. To submit your Security Consent Form select the Account Management button on the Home Page and then choose the Security Consent Form option.
18. I have an established record PECOS. How do I select ‘Revalidation’ as the reason for submission?
If you do have a PECOS enrollment record established, under ‘My Enrollments’, you should first select ‘View Enrollments’, then select ‘Revalidation’.
19. What is the definition of a Sole Owner and which CMS-855 application is required for revalidation?
If an individual is the sole owner of a professional corporation, a professional association, or limited liability company and bills Medicare through this incorporated business entity for only his / her Medicare services, the individual is considered a “Sole Owner”.
Complete Sections 1, 2, 3, 4A, and 4C through 17 of the CMS-855I application for the business entity:
Section 1A – provide the individual’s Type 1 NPI
Section 4A – provide the entity’s Type 2 NPI
Section 4C – provide the entity’s Type 2 NPI and PTAN
If the entity has not yet received a Type 2 NPI, access National Plan and Provider Enumeration System (NPPES) to request one.
If, as a result, of the revalidation application, a change is required in the structure of the existing enrollment record (i.e., the existing record is not established as a Sole Owner), a PTAN is assigned under the entity’s employer identification number (EIN). The sole owner / individual will be reassigned to the entity and issued a rendering PTAN under his/her EIN or social security number (SSN).
A new CMS-588 EFT form will also be required to allow the entity to receive payments via EFT. Complete the CMS-588 with the entity’s information (i.e., Type 2 NPI, etc.).
If an enrollment record currently exists under the same EIN number (i.e. the individual previously established as a sole proprietor), the PTAN associated with that enrollment record will be end dated to allow creation of the new enrollment since multiple enrollments cannot exist under the same EIN.
20. I am a sole owner of a corporation. I have group members assigned to my group, but I do not render services, which application should I submit?
You should submit the CMS-855B application. However, it is possible the individual physicians/non-physician practitioners reassigning benefits to your corporation will also receive requests to revalidate. In this case, the physician/non-physician practitioner will submit a CMS-855I and declare all reassignments on that application in section 4B, which would include your corporation’s information (CMS-855R applications are not required).
Please visit the Enrollment Forms page of our website to download the CMS-855B application.
21. What is the definition of a sole proprietorship and which CMS-855 application is required for revalidation?
A business is a sole proprietorship if it meets the following criteria:
It files a Schedule C (1040) with the IRS (this form reports the business’s profits / losses);
One person owns all of the business’s assets; and
It is not incorporated.
Complete Sections 1, 2, 3, and 4C through 17 of the CMS 855I application for the business.
Section 1A – provide the individual’s Type 1 NPI
Section 4C – provide the individual’s Type 1 NPI and PTAN
Section 4F – provide the TIN. This could be an EIN or SSN.
If, as a result, of the revalidation application, a change is required in the structure of the existing enrollment record, a new PTAN is assigned under the sole proprietor’s TIN.
If an enrollment record currently exists under the same TIN (i.e. the individual previously established as a sole proprietor), the PTAN associated with that enrollment record will be end dated to allow creation of the new enrollment since multiple enrollments cannot exist under the same TIN.
A new CMS-588 EFT form will also be required to allow the individual to receive payments via EFT.
22. How long will it take to process my revalidation application?
Paper Applications that require a site visit:
80% of applications will be processed within 80 calendar days of receipt
90% of applications will be processed within 150 calendar days of receipt
95% of applications will be processed within 210 calendar days of receipt
Paper Applications that do not require a site visit:
80% of applications will be processed within 60 calendar days of receipt
90% of applications will be processed within 120 calendar days of receipt
95% of applications will be processed within 180 calendar days of receipt
Internet-based PECOS Applications that require a site visit:
80% of applications will be processed within 80 calendar days of receipt
90% of applications will be processed within 90 calendar days of receipt
95% of applications will be processed within 120 calendar days of receipt
Internet-based PECOS Applications that do not require a site visit:
80% of applications will be processed within 45 calendar days of receipt
90% of applications will be processed within 60 calendar days of receipt
95% of applications will be processed within 90 calendar days of receipt
23. I received a revalidation letter for my group. Do I have to revalidate all of my group members as well?
No. You only need to revalidate the group file by submitting a CMS-855B. However, it is possible the individual physicians / non-physician practitioners reassigned to your group will also receive requests to revalidate. In this case, the physician/non-physician practitioner will submit a CMS-855I and declare all reassignments on that application in section 4B, which would include your group’s information (CMS-855R applications are not required).
24. Where are revalidation letters mailed?
Hardcopy letters will be sent 2-3 months in advance of the due date to at least two addresses on file: (Correspondence, Special payment (aka pay-to), and/or Primary practice address). 
25. I received a revalidation letter with multiple active PTANs listed on it. I want to revalidate some of the PTANs, but voluntarily terminate others. What should I do?
List only the PTANs you want to remain active via the revalidation process on your CMS-855 application. If we find additional active PTANs in our records not listed on the application, we will call you (or your designated contact person) to confirm if the undisclosed PTANs should be voluntarily terminated / deactivated. Upon confirmation, the date you signed the application is the effective date of termination for those PTANs.
26. What address should I use to mail my revalidation application and / or supporting documents?
Phase 3 (requests dated after September 20, 2013) and Cycle 2 requests dated on or after March 18, 2016:
Jurisdiction H
Novitas JH Provider Enrollment
P.O. Box 3095
Mechanicsburg, PA 17055-1813
Jurisdiction L
Novitas JL Provider Enrollment
P.O. Box 3157
Mechanicsburg, PA 17055-1836
Jurisdiction JH/Jurisdiction JL Priority Mail/Commercial Courier (PO Box cannot be used)
Novitas Solutions
Provider Enrollment Services
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050
Note: Although Internet-based PECOS instructs providers to send hardcopy supporting documentation to a specific Novitas address, please mail all Phase 3 and Cycle 2 revalidation documents to one of the addresses listed above.
27. I am a group submitting a revalidation application, should I access the Reassignment grid if the change does not affect the reassignments on file or additional reassignments?
When submitting a revalidation or a change of information application via Internet-based PECOS, please do not submit existing reassignments unless you are terminating the reassignment or requesting a change to the reassignment effective date. If you are not making one of these changes, it is not necessary to access the reassignment grid or provide an e-signature for each existing reassignment since doing so creates unnecessary application submissions that we must review and appropriately disposition.
Please be assured that any other change to the group / organization enrollment record (e.g., adding a practice location or a new National Provider Identifier) automatically applies to all existing reassignments. It takes time for us to review these records, which ultimately affects the amount of time it takes us to finalize your revalidation or change of information request, so help us help you by not submitting unnecessary reassignment submissions.
28. I enrolled solely to order, certify and / or prescribe via the CMS-855O application, will I be required to revalidate?
No, you will not be required to revalidate.
29. I opted out of the Medicare program, will I be required to revalidate?
No, you will not be required to revalidate.
30. I need to submit a change of information to my existing enrollment information, should I wait until I receive my revalidation notice?
No, the revalidation effort does not change other aspects of the enrollment process. Continue to submit changes (i.e., changes of ownership, change in practice location or reassignment, final adverse action, etc.) as they always have. If you also receive a request for revalidation, respond separately to that request.
31. What happens if I don't respond to the request for a revalidation application or a request for additional information?
You must submit a complete revalidation application by the established due date and respond to all requests for additional information. Failure to submit a revalidation application will result in a hold on Medicare payments and subsequent deactivation. If we receive the revalidation application, but do not receive additional information requested within 30 days, it may result in deactivation of your Medicare billing privileges.
32. How do I reactivate my Medicare billing privileges if deactivated for non-response?
In order to reestablish Medicare billing privileges subsequent to deactivation, submit a new, fully completed application. An interruption in billing will occur during the period of deactivation resulting in a gap in coverage.
After a period of deactivation, the reactivation date is the receipt date of the new, fully completed application. We cannot grant retroactive billing privileges.
Services provided to Medicare patients during the period between deactivation and reactivation are the provider's liability.

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Last modified:  10/31/2018