Recently a member experienced some issues with the required Medicaid revalidation process, so I wanted to provide some background and current information on provider revalidation. Please review this information.
Under the Affordable Care Act (ACA), the Indiana Health Coverage Programs (IHCP) is required to revalidate all provider enrollments, applying ACA criteria. A summary of these criteria is located on the Affordable Care Act (ACA) Requirements page of indianamedicaid.com.
Beginning in March 2012, IHCP revalidated all providers whose enrollments became effective before January 1, 2012. These revalidations were scheduled in phases and should have been completed by December 31, 2015.
Some providers are now in the cycle for the next revalidation process.
Providers will receive a notification letter with instructions for revalidating 90 days before their revalidation deadline. A second notification letter will be mailed 60 days before the revalidation deadline. Providers with multiple service locations must revalidate each location individually and will receive a separate letter for each location.
Providers should not take any steps to revalidate until they receive their notification letters. The notification letters will be mailed to the Mail To address on the provider’s IHCP profile. In preparation, providers should verify the accuracy of the Mail To ad-dress on file by accessing the Provider Profile feature of Web interChange.
The revalidation process can take up to 20 business days to process, so providers are strongly encouraged to submit revalidation paperwork well in advance of their established deadlines. Providers that fail to submit revalidation paperwork in a timely manner will be deactivated from participation in the IHCP as of the deadline date. Deactivation of a provider’s enrollment results in the following consequences:
- Claims billed with dates of service on or after the deactivation date will be denied.
- Providers who participate in the managed care pro-grams will have their members
reassigned to other primary medical providers (PMPs).
- Members with level-of-care (LOC) services and those in the Right Choices Program
(RCP) may be denied benefits.
Providers that submit revalidation paperwork after their enrollment is deactivated, and who meet all enrollment criteria, will be re-enrolled in the IHCP. However, because the re-enrollment date cannot be back-dated, there would be a period of time during which the provider’s enrollment would be inactive. Providers are cautioned to return revalidation paperwork on time to avoid deactivation or a gap in enrollment.
Revalidation of enrollment will occur on a regular schedule. Under the ACA, states are required to revalidate providers at intervals not to exceed every five years. A more frequent three-year revalidation requirement applies to durable medical equipment (DME) and home medical equipment (HME) providers, including pharmacy providers with DME or HME specialty enrollments. Providers will be notified every three or five years when it is time to revalidate their IHCP enrollments.
• We have had members asking about the ability to check their revalidation deadlines. We have been pointing them to the revalidation page at www.indianamedicaid.com but the listing on that page only has deadlines through January 31, 2017. Will this listing be updated or how can a provider check upcoming deadlines?
• Providers will be able to check revalidations deadlines that may occur after 1/31/2017, thru the new CORE MMIS web portal, which will be online 2/13/2017. Go here to see FAQs that address revalidation information for providers.