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 DME suppliers to revalidate every three years. (Reference 42 CFR 424.515).

CMS began their second revalidation cycle in March 2016.

For each revalidation cycle:

1. CMS will post the provider/supplier’s due date to revalidate on their Medicare Revalidation Lookup Tool at https://data.cms.gov/revalidation
2. NGS will notify our providers and suppliers by letter when they are scheduled to revalidate. The letter received from us may include the following information:
   1. Due Date
   2. Provider Name
   3. NPI and PTAN combination
   4. Legal Business Name/DBA name
   5. State
   6. Tax ID (last four digits)

Note: The revalidation process does not change or alter normal provider enrollment laws for Medicare. If you have a change of address, reassignments, additions to practice, changes in authorized officials or other information updates you are still required to submit that change within 30 days. You cannot wait for revalidation to update your enrollment record; it is not in compliance with Medicare regulation.

Please see web link below for sample of the revalidation envelope:

• Revalidation Envelope Sample

How Does a Provider/Supplier Revalidate Their Enrollment?

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

Does the Application Fee Apply to Revalidation?

How Does a Provider/Supplier Revalidate Their Enrollment?

Two ways to submit your revalidation:

1. The most efficient way to submit your revalidation information is by using the Internet-based PECOS.
   1. To revalidate via the Internet-based PECOS at https://pecos.cms.hhs.gov.

2. You may also submit your revalidation by mail.
   • Please complete the appropriate CMS-855 Application Form and mail it to the address indicated on the revalidation letter we mailed and/or emailed to you.
   • The CMS 855 Applications are available on our website
     • From the NGS home page, select ENROLLMENT and then select Enrollment Forms
     • Or Click here

Additional Information

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

Note: If there is missing or incomplete information on the application, you will receive a letter from our Provider Enrollment department requesting the missing information. We will advise you how to send the information back to us. You have 30 days to respond to these Additional Development Requests. If you do not respond within the 30 days, your PTAN may be deactivated. Once deactivated, you must submit a new and complete application. You will receive a new effective date and will have a gap in billing privileges..

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

Visit our Enrollment webpage click on Obtain Revalidation Instructions from the left navigation pane

Questions/concerns specific to your revalidation application processing information should be addressed to us at:

• J6 MAC states: Illinois, Minnesota, and Wisconsin call 877-908-8476
• JK MAC states: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont call 888-379-3807

Questions concerning PECOS system issues should be addressed to the CMS EUS Help Desk

• Toll-Free Telephone: 866-484-8049
• Email: EUSSupport@cgi.com

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

• Toll-Free Telephone: 866-238-9652
• Email: http://www.palmettogba.com/palmetto/Feedback.nsf/Feedback?OpenForm&SendTo=12

Does the Application Fee Apply to Revalidation?

If you are one of the provider types listed below you must pay the $569 application fee via the https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do; submit a copy of your payment receipt with the application.

Click here for additional information regarding the enrollment application fee:

• Ambulance service supplier
• Ambulatory surgery center (ASC)
• Independent clinical laboratory (CLIA)
• Independent diagnostic testing facility (IDTF)
• Portable X-ray supplier
• Mammography center
• Mass immunization/roster biller
• Pharmacy
• Radiation therapy center
• Histocompatibility laboratory