Description of Revalidation

Section 6401(a) of the Affordable Care Act requires that all enrolled providers or suppliers revalidate their Medicare enrollment information under new enrollment screening criteria.

To maintain Medicare billing privileges, a provider or supplier must resubmit and recertify the accuracy of its enrollment information every five years.  

CMS has completed its initial round of revalidations and  resuming regular revalidation cycles in accordance with 42 Code of Federal Regulation, Section 424.515, Federal Register 2/2/2011 (CMS-6028-FC).

General CMS-Medicare revalidation information is available on the CMS website, Revalidations page.

• The revalidation requirement does not apply to physicians and nonphysician practitioners who have opted out of Medicare.
• The revalidation requirement does not apply to physicians and nonphysician practitioners who enroll solely to order and refer (CMS-855O).
• CMS has established due dates by which you must revalidate. Generally, this due date will remain with you throughout subsequent revalidation cycles.
• To remain in compliance with Medicare provider enrollment regulations and avoid deactivation of Medicare billing privileges, a completed and accurate application must reach National Government Services by the due date.
• Unsolicited applications will be returned if received more than seven months prior to the provider or suppliers revalidation due date. Please verify the revalidation due date on the CMS Medicare Revalidation List Tool.
• To avoid Medicare payment being placed on hold or termination of Medicare billing privileges, respond timely to additional information requested.

Related Content

• CMS Revalidations