Medicare revalidation process - how often provide need to do - FAQ

Q: How will I know when it’s time for me to revalidate? Should I submit my revalidation application now?

A: First Coast Service Options, Inc. (First Coast) will be mailing revalidation request letters-- enclosed within yellow envelopes -- to affected providers.





You will know when it is time for you to revalidate when you receive a revalidation request letter from First Coast. You should not submit your enrollment application (e.g., CMS-855I, CMS-855B, CMS-855A) until you have received your revalidation request letter.

Q: When will I receive my revalidation request letter? Is there an easy way for my staff to identify the letter?
A: First Coast Service Options, Inc. (First Coast) will be mailing revalidation request letters to affected providers. You may receive a revalidation request -- enclosed within a yellow envelope -- at any time during that time period.

How to easily identify the revalidation request letter:
validation request envelope
• The revalidation request letter will be enclosed within a yellow envelope
• The phrases Open Immediately and Urgent Request will be stamped on the yellow envelope
• The return address will list First Coast
• Click here external pdf file to view a sample revalidation letter on the CMS.gov website.
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/SampleRevalidationLetter.pdf


Q: How long do I have to submit my revalidation application? What will happen if I don’t respond?

A: Once you have received your revalidation request, please don’t wait. First Coast Service Options, Inc. (First Coast) must receive your enrollment application within 60 days.
Note: If First Coast does not receive your application within 60 days, your Medicare payments will be withheld, and your billing privileges will be deactivated. You will be required to submit your enrollment application to reactivate your billing privileges.



Q: I just received a revalidation request letter from First Coast Service Options Inc. (First Coast). Where can I find more information regarding the provider revalidation process and how to properly respond to a revalidation request?

A: First Coast Service Options (First Coast) will be mailing revalidation request letters to affected providers. You may receive a revalidation request -- enclosed within a yellow envelope -- at any time during that time period.

A revalidation is a complete and thorough re-verification of the information contained in your Medicare enrollment record to ensure it is still accurate and compliant with Medicare regulations.


CMS 855O Enrollment Form

Must enter into a private contract with patients for Can become an active billing Medicare provide covered Medicare services prior to the service at any time by submitting the CMS 855I enrollment being performed (exception for emergency care application (and any additional information or services as defined by CMS). enrollment forms required).

CMS 855I Form The CMS enrollment application for an individual to complete to enroll in Medicare if they plan to bill Medicare for covered services.

https://www.healthlawyers.org/Events/Programs/Materials/Documents/MM12/papers/V_joy.pdf

CMS 855 application not needed (most common—individual physician submits an 855i at the same time the physician submits an 855r to reassign to new group and there are no changes in the 855i application).

a. Practice Note: It is helpful for physicians to complete an 855i change of information application to update their correspondence addresses when reassigning to new groups.

b. Physicians should also submit 855r applications to terminate old reassignments or individual practice PTAN numbers.

c. Caveat: Some MACs mistakenly treat the 855i change of information applications as superfluous if the physician already has a record in PECOS and these changes are not always processed. (Basically the processors miss the fact the physician is changing information).

d. If a physician is reassigning to a group that has more than one PTAN number under a single Tax ID number, only one 855R is required, but we recommend sending a separate 855R for each PTAN to ensure that the notification letter, which contain the newly issued PTAN numbers are issued for each group PTAN number. Some MACs have difficulty issuing separately PTAN letters when only one 855r is filed.



Definition FAQ
Q: What is revalidation?

A: When you first enrolled or made changes to your enrollment information, First Coast Service Options Inc. (First Coast) validated the accuracy of the information you submitted and ensured its compliance with Medicare regulations before approving your enrollment application.
A revalidation is a complete and thorough re-verification of the information contained in your Medicare enrollment record to ensure it is still accurate and compliant with Medicare regulations. When you submit your revalidation application (e.g., CMS-855I, CMS-855B, CMS-855A), all applicable sections must be completed on the revalidation application, and all applicable attachments must be submitted.




When to revalidate FAQ
Q: How will I know when it’s time for me to revalidate? Should I submit my revalidation application now?

A: The Centers for Medicare & Medicaid Services’ (CMS) established due dates for revalidation will be posted online at https://data.cms.gov/revalidation external link. The revalidation applications can be submitted within six months prior to this due date. If there is no date listed and displays “TBD” (to be determined), then you are not required to submit your revalidation yet.
First Coast Service Options Inc. (First Coast) will also be mailing revalidation request letters-- enclosed within yellow envelopes -- to affected providers within two to three months prior to the provider’s revalidation due date.



Revalidation mailing FAQ
Q: When will I receive my revalidation request letter? Is there an easy way for my staff to identify the letter?

A: First Coast Service Options Inc. (First Coast) will be mailing revalidation request letters to affected providers. You will receive a revalidation request -- enclosed within a yellow envelope – two to three months (approximately 75-90 days) prior to your due date. Due dates may be obtained online at https://data.cms.gov/revalidation external link. If “TBD” (to be determined) is listed with no due date, your revalidation is not due yet.
How to easily identify the revalidation request letter:
Provider Enrollment Revalidation Envelope
• The revalidation request letter will be enclosed within a yellow envelope
• The phrases Open Immediately and Urgent Request will be stamped on the yellow envelope



Where will it be sent FAQ
Q: Where will First Coast Service Options Inc. (First Coast) mail my revalidation request letter? Will I receive more than one letter?

A: First Coast will mail two letters requesting revalidation to ensure your receipt utilizing two of the three addresses listed below:
• Correspondence
• Special payments
• Primary practice




Revalidation deadline FAQ
Q: How long do I have to submit my revalidation application? What will happen if I don’t respond?

A: You may submit your revalidation application six months prior to the Centers for Medicare & Medicaid Services’ (CMS’) due date listed online at https://data.cms.gov/revalidation external link. You will also receive a request from First Coast Service Options Inc. (First Coast) to submit your revalidation application by the established due date within two to three months prior to that due date.
Note: If First Coast does not receive your revalidation application, your Medicare payments will be withheld, and your billing privileges will be deactivated. You will be required to submit your enrollment application to reactivate your billing privileges. Deactivations will take place approximately 60-75 days after the due date.



What to include FAQ
Q: What should I include with my revalidation application? Do I need a coversheet?

A: As with any CMS-855 application that is submitted, a signed and dated certification page and any supporting documentation that is needed to process your application should be submitted.
You should also include the coversheet -- which you will find enclosed with your revalidation request letter from First Coast Service Options (First Coast) -- and place the coversheet on top of your application submission.
Note: The purpose of the coversheet and its placement is to ensure that your application is easily identified as a response to a revalidation request.
If you are submitting your revalidation prior to receipt of First Coast’s letter based upon the due date listed online at https://data.cms.gov/revalidation external link, then the coversheet is not required. First Coast will identify these as revalidations.


Multiple letters received FAQ
Q: I received more than one revalidation request letter. Why did you send more than one?
A: If you have more than one address listed in your file (e.g., special payments, pay to address), your revalidation request letter may be sent to multiple addresses. Revalidation request letters are sent to multiple addresses listed within a provider’s file to increase the chances that he or she will receive the revalidation request letter.


Multi-practice group FAQs
Q: I work for three multi-practice groups, and a separate revalidation request letter was sent to each of the three practice addresses. Do I have to submit three separate enrollment applications (CMS-855I) and three reassignment (CMS-855R) applications?

A: Complete and submit one CMS-855I by downloading the form or submitting through Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Ensure to complete Section 4B where you will need to identify all of your current reassignment of benefits to groups in which you are still working.
Note: First Coast Service Options Inc. (First Coast) must receive all applications by the Centers for Medicare & Medicaid Services established due date found online at https://data.cms.gov/revalidation external link, or Medicare payments will be withheld, and billing privileges will be deactivated. You will be required to submit your enrollment application to reactivate your billing privileges.


Sole owner but multiple locations FAQ
Q: I am the sole owner of two practice locations. Do I need to submit a CMS-855I for each location?

A: For practices that operate under the same Tax Identification Number (TIN), you will need to submit only one CMS-855I application; however, you will need to include two Section 4C pages to identify each practice location.
For practices that operate under separate TINs, you will need to submit separate CMS-855I applications for each of the practices.


Multiple hospitals FAQ
Q: I practice at multiple hospitals; however, I do not have a physical office location at any of the hospitals. Mail sent to these hospitals is frequently lost. How will I know if I have received a revalidation letter?

A: You may identify your revalidation due date online at https://data.cms.gov/revalidation external link. You can also determine if a letter has been mailed by accessing the Confirm a Revalidation Request lookup on the First Coast Service Options (First Coast) provider website.
First Coast also recommends that you notify the hospital administrator or office staff to hold/deliver the revalidation letter for you.
Let them know how they can easily identify the revalidation letter:
Medicare revalidation letter
• The revalidation request letter will be enclosed within a yellow envelope
• The phrases Open Immediately and Urgent Request will be stamped on the yellow envelope
• The return address will list First Coast Service Options, Inc. (First Coast)
If you have more than one address listed in your file (e.g., special payments, pay to address), your revalidation request letter may be sent to multiple addresses. Revalidation request letters are sent to multiple addresses listed within a provider’s file to increase the chances that he or she will receive the revalidation request letter.

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