Skip to Main Content
 
 
 
Web Content Viewer

Congressional Offices

Web Content Viewer

Provider Revalidation Fact Sheet for Congressional Field Offices

The Affordable Care Act, Section 6401 (a), requires enrolled providers to revalidate their Medicare enrollment every five years, and enrolled durable medical equipment suppliers to revalidate every three years. (Reference 42 CFR 424.515). The second five-year revalidation cycle began in March 2016 for all currently enrolled providers/suppliers.

How Will You Know it is Time To Revalidate?

The Centers for Medicare & Medicaid Services (CMS) will post the provider/supplier’s revalidation due date on the Medicare Revalidation List tool at https://data.cms.gov/revalidation.

National Government Services will notify our providers/suppliers by letter when they are scheduled to revalidate. The letter may include the following information:

  • Due date
  • Provider name
  • National Provider Identifier (NPI) and Provider Transaction Access Number (PTAN) combination
  • Legal business name/doing business as (DBA) name
  • State
  • Tax ID (last four digits)

View a revalidation envelope sample.

Can a Change in Information for an Enrollment Wait Until Revalidation?

The revalidation process does not change or alter normal provider enrollment laws for Medicare. You cannot wait for revalidation to update your enrollment record; it is not in compliance with Medicare regulation.

You must report changes of information in your Medicare enrollment records within 30 days for:
  • Change(s) in reassignments or employee arrangements
  • Change(s) in bank account information
  • Change(s) in ownership
  • Change(s) in an authorized or delegated official
  • Change(s) in practice location
  • Final adverse legal action(s)

All other changes to your existing Medicare enrollment records must be reported within 90 days.

How Does a Provider/Supplier Revalidate Their Enrollment?

The most efficient way to submit your revalidation information is by using PECOS at https://pecos.cms.hhs.gov/pecos/login.do#headingLv1 or complete and submit the appropriate CMS-855 Part A or CMS-855 Part B paper applications. Mail the paper application to the address indicated on the revalidation letter. Current copies of the applications are available on our website by selecting Enrollment and then Enrollment Forms.

Use the Revalidation Application Checklist to ensure you have included all information in your revalidation application

While processing the application(s), NGS may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days from the initial development letter date or claims payment will be impacted. If you do not respond within the 30 days, your PTAN may be deactivated.

If deactivated, you must submit a new and complete application to reactivate. You will maintain original PTAN, receive a new effective date and have a gap in billing privileges.

Does the Application Fee Apply to Revalidation?

The application fee is required during revalidation for select provider types.

If you are one of the provider types listed below you must pay the $586 application fee via the Medicare Application Fee Information page at https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do#headingLv1. Submit a copy of your payment receipt with the application.

  • Ambulance service suppliers
  • Ambulatory surgical center (ASC)
  • Community mental health center
  • Competitive Acquisition Program (CAP)/Part B Drug Vendor
  • Comprehensive Outpatient Rehabilitation Facility
  • Critical access hospital (CAH)
  • Durable medical equipment, prosthetic, orthotic and supplies (DMEPOS)
  • End-stage renal disease (ESRD) facility
  • Federally qualified health center (FQHC)
  • Histocompatibility Laboratory
  • Home health agency (HHA)
  • Hospice
  • Hospital
  • Independent Clinical Laboratory (Clinical Laboratory Improvement Amendments [CLIA])
  • Independent diagnostic testing facility (IDTF)
  • Indian Health Services Facility
  • Mammography Center
  • Mass Immunization (Roster Biller Only)
  • Organ Procurement Organization
  • Pharmacy
  • Portable X-ray Supplier
  • Radiation Therapy Center
  • Religion Nonmedical Health Care Institution
  • Rural health clinic (RHC)
  • Skilled nursing facility (SNF)

Visit our website under the Enrollment tab for more information about the application fee or to use the NGS Medicare Enrollment Application Fee Decision Tree tool.

What if a Provider/Supplier Has Additional Questions Regarding Revalidation?

Visit our website, select the Enrollment tab then Revalidate My Enrollment for detailed information.

Please contact NGS with questions specific to your revalidation application processing.

  • J6 Part A, FQHC and HHH: 855-834-5596
  • J6 Part B: 877-908-8476
  • JK Part A, FQHC and HHH: 855-593-8047
  • JK Part B: 888-379-3807

Questions specific to DME, prosthetic, orthotic and supply suppliers should be addressed to the National Supplier Clearinghouse at:

Questions specific to PECOS system issues should be addressed to the CMS EUS Help Desk at:

Updated 2/14/2019

Provider Revalidation Fact Sheet for Congressional Field Offices
Complementary Content