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CMS Revalidation Includes Mental Health
November 1, 2009

The Centers for Medicare and Medicaid Services (CMS) is conducting provider enrollment revalidation for selected Medicare Part A and B providers, practitioners, and suppliers. Highmark Medicare Services will send revalidation letters to approximately 300 Part A providers and 2,900 Part B providers within the J12 jurisdiction between October 2009 and January 2010. The letters will be mailed to the latest practice address on the master provider file. Highmark will notify providers via listserv that letters have been sent. Change Requests related to the revalidation initiative are:

Part A

  • 6486 - Skilled Nursing Facility (SNF) Provider Enrollment Revalidation  
  • 6665 - Community Mental Health Center (CMHC), Comprehensive Outpatient Rehabilitation Facility (CORF), Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Provider Enrollment Revalidation

Part B

  • 6485 – Part B Organizational Supplier Enrollment Revalidation
  • 6574 -  Part B Individual Practitioner Supplier Enrollment Revalidation
  • 6666 - Medicare Part B Portable X-ray Supplier Enrollment Revalidation

Providers that receive letters must submit the revalidation application promptly. If an application is not received within 60 calendar days from the date of request, CMS must revoke billing privileges and impose a one year re-enrollment prohibition. The provider is barred from participating in the Medicare program for one year from the effective date of the revocation. The revocation is effective 30 days after the notification of action is mailed. The notification also addresses the right to appeal.

If a provider does not receive a letter requesting revalidation, no action is needed. Providers are instructed not to send an application for revalidation if they do not receive a letter. A Revalidation Inquiry Tool is available from Highmark Medicare Services to identify whether a provider will receive a revalidation letter.

 

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