Novitas: Complete Provider Enrollment Revalidation Cycle 2 to prevent potential loss of revenue

Friday, August 19, 2016 01:29 PM

All Medicare Part A and B providers are required to recertify the accuracy of their enrollment information every five years through a process known as revalidation. The initial five-year revalidation cycle was completed in 2015 and the Centers for Medicare and Medicaid Services began Cycle 2 in March 2016. The current response rate is 50 percent.

The federal CMS implemented improvements to streamline the revalidation process during Cycle 2. One enhancement is that the agency is establishing due dates with six months’ advance notice of when the revalidation application must be received by to remain compliant with Medicare’s revalidation requirements. The federal CMS posts the due dates for all currently enrolled providers in the Medicare Revalidation Lookup Tool at Data.CMS.gov/revalidation. A due date of “TBD” (to be determined) means that the agency has not set the date yet. An application will be considered “unsolicited” if it is submitted but the provider/supplier is not due for revalidation in the current six-month period. If a due date is not established (i.e., “TBD”), a revalidation application should not be submitted. All unsolicited revalidation applications will be returned by Novitas.

The Revalidation Lookup Tool is updated every 60 days, so Novitas encourages providers to check the tool periodically and respond timely once your due date is established. Novitas is also issuing notices by mail to providers two to three months in advance of the due date.

Providers/suppliers must submit a complete revalidation application by the established due date and respond to all requests for additional information issued by Novitas in a timely manner. Failure to submit a revalidation application will result in a hold on Medicare payments and subsequent deactivation if the application is not submitted. If the revalidation application is received, but additional information is requested (through development) and not received within the allotted 30-day timeframe, the provider’s Medicare enrollment will be deactivated.

Read more in this bulletin from Novitas. If you have questions, please contact the Novitas Provider Enrollment Help Line at 1-855-252-8782.