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.
- 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.
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.
Article ID: 514, Created On: 8/9/2024, Modified: 8/9/2024