514- Revalidation and Recertification for Medicaid-enrolled Providers

Revalidation vs. Recertification

For Medicaid-enrolled providers, maintaining your enrollment status is crucial. Termination of enrollment will result in rejected billing claims. Please review the information below on the two types of Medicaid enrollments to ensure you understand the requirements and remain current with your enrollment. 

• Recertification is done annually and is related to submitting claims electronically to Medicaid.   As the annual recertification approaches, both Public Consulting Group and Medicaid will contact providers with the necessary renewal paperwork. 
  
  Providers who have lapsed in recertification will receive paper remittances. Providers must notify PCG upon receipt, as the paper remittance data will need to be manually entered into the system. Failure to notify PCG will result in the Medicaid adjudication (payments and denials) not being posted.
  
  
• Revalidation is done every five years to revalidate enrollment with Medicaid according to Federal regulation 42 CFR 455.414.  Revalidation includes providing information on the provider’s ownership, managing employees, agents, persons with a control interest, as well as providing current addresses, specialties, etc. Please note:  Public Consulting Group does not have access to provider’s revalidation timeframes, so it is of the utmost importance that providers respond to Medicaid’s request for revalidation to avoid termination of Medicaid enrollment. 
  
  If providers receive revalidation lapse rejections (A7:132:85 - Entity’s Medicaid provider ID) from Medicaid, they must request Medicaid to backdate the revalidation date and resubmit the claims for processing from the Workable Claims queue (Category 2: 277 rejections) in the Billing module. Claims denied due to a lapse in validation are not eligible for escrow reimbursement.

eMedNY has a presentation that is an overview of the revalidation process:  https://www.emedny.org/info/ProviderEnrollment/revalidation/Revalidation_of_Medicaid_Providers.pdf 

Steps to Revalidate:

1.  Visit the Provider Enrollment page:  https://www.emedny.org/info/ProviderEnrollment/revalidation/index.aspx

2.  Locate your enrollment form as well as additional required documentation

3.  Determine whether an enrollment fee is required. 

4.  Complete and mail the appropriate form(s) with all required documentation to the address provided. 

It is recommended that providers retain a copy of the forms and documentation. 

For additional questions, please contact the eMedNY Call Center at 800-343-9000 and select Option 2, then option 2 a second time.