Novitas Solutions, Inc, the Medicare Administrative Contractor (MAC) for the fee-for-service program in Pennsylvania has an important notice.
Provider Enrollment Revalidation Cycle 2
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 & Medicaid Services (CMS) began Cycle 2 in March 2016.
CMS implemented improvements to streamline the revalidation process during Cycle 2. One enhancement is that CMS 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.
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 CMS 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 they are encourage 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
In order to reestablish Medicare billing privileges subsequent to deactivation, the provider/supplier is required to submit a new, fully completed application. The provider/supplier will maintain their original Provider Transaction Access Number (PTAN); however, an interruption in billing will occur during the period of deactivation resulting in a gap in coverage.
- The reactivation date after a period of deactivation will be based on the receipt date of the new, fully completed application. Retroactive billing privileges during the period of deactivation will not be granted. Services provided to Medicare patients during the period between deactivation and reactivation are the provider’s liability.
Novitas encourages providers/suppliers to utilize Internet-based PECOS (PECOS Web) to submit their revalidation application. This is the fastest and most efficient method for submission of revalidations.
The processing status of Cycle 2 revalidation applications can be obtained utilizing the Provider Enrollment Status Inquiry Tool located on Novitas’ website.
Please access the following key resources for additional information:
- Provider Enrollment Status Inquiry Tool –
- Jurisdiction L – http://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004864?proto=http&domain=www.novitas-solutions.com&space=Medicare JL
- Jurisdiction H – http://www.novitas-solutions.com/webcenter/content/conn/UCM_Repository/uuid/dDocName:00004864?proto=http&domain=www.novitas-solutions.com&space=MedicareJH
- Revalidation Helpful Hints and Reminders –
- Internet-based PECOS (PECOS Web) – https://pecos.cms.hhs.gov/pecos/login.do
- MLN® Special Edition (SE) 1605 article – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1605.pdf
- Revalidation Cycle 2 FAQs – https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/Reval_Cycle2_FAQs.pdf
- CMS’ Revalidation page – https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Revalidations.html
This communication is from Novitas’ Provider Outreach and Education department. If you have questions, please contact our Provider Enrollment Help Line at (JL) 1-877-235-8073 or (JH) 1-855-252- 8782.