Section 6401(a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their Medicare enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled in Medicare prior to March 25, 2011. We previously completed Phase I and Phase II of this project. We have entered Phase III, which includes sending letters to the remaining 70% of providers in Jurisdiction H and Jurisdiction L that have not received a revalidation request from Novitas. These letters will be sent to two of the following addresses; correspondence, special payment (aka pay-to) or primary practice address.
There is no need to take any proactive measures at this time. However, if/when you receive a request for revalidation; please follow the instructions in the letter very carefully. Remember that failure to submit the appropriate required enrollment forms may result in the deactivation of Medicare billing privileges.
When completing the revalidation form, please be sure that all fields are filled out completely and accurately. Novitas is developing on approximately 80% of revalidation paper applications and approximately 40% of revalidation web applications that we receive. The top reasons for development are listed in the chart below.
Section 1A - 855I
Not all active PTANs listed
Section 2A - 855I
Incorrect / missing license number
Missing first / last name, date of birth, former name, social security number
Section 3 - 855I / 855B / 855A
Section 4A - 855I
Incorrect NPI number listed
Section 4B - 855I
Active reassignment information not listed
Section 4A / 4C - 855I / 855B
Missing date of first Medicare patient seen at this location
PTAN / NPI not listed
Incorrect/incomplete zip code
Section 5 and / or 6A / B - 855B / 855A
Missing owner / managing employee info
Section 8 - 855B / 855I
Missing billing agency
No financial institution contact person listed or only a first name or title listed
SSN / EIN box not checked
Missing voided check / bank letterhead
Individual / sole proprietor / sole owner not filling out correct sections on application:
Sole Owner corporation should complete sections 1, 2, 3, 4A and 4C through 17
Sole proprietor should complete sections 1, 2, 3, and 4C through 17
Not submitting supporting documents (certifications, tax documents, transcripts, degrees, etc.)
Legal business name wrong, not listed or incorrect per NPPES (National Plan and Provider Enumeration System)
Wrong application submitted (i.e., submitting 855B for a Sole Owner corporation versus 855I)
Faxing information when required to mail
Incorrect person signing application (i.e., contact person instead of provider / authorized and delegated official (AO / DO))
Fee not paid
Novitas will develop to obtain any missing or incomplete information. If the information is not received within the timeframe outlined in the development letter, you run the risk of having your provider number deactivated.
Please make sure to submit your paperwork correctly on the first submission and if requested, respond to the development letter within the timeframes indicated.
If you have specific questions on how to revalidate, please review our Revalidation FAQs (Frequently Asked Questions).