Provider Revalidation Pointers

Provider Revalidation Pointers

RCPA has been contacted by providers having difficulty with the revalidation process. After contacting the Office of Medical Assistance Programs (OMAP), the following tips and pointers were offered to ease and speed up the revalidation process. After mailing 80,000 reminder letters, the 800 number for assistance was unable to be manned properly; this has been corrected and providers are urged to contact the state next week.

You must ensure that the provider has reviewed and included the items in the application that are on the provider checklist at the end of the application (such as social security card, provider license, corporation papers, etc.). Most of the applications are sent back because the provider did not send a copy of a license, social security card, or corporation’s papers, or they send W-9s when the instructions say not to.

Providers often do not send the additional requirements for that provider type or specialty. Each provider type has additional requirements to what is on the checklist at the end of the application. Many providers fill out the application and submit it – then OMAP must send it back because the provider did not review, understand, or submit the additional requirements. For example:

Additional Required Documents for Provider Type 08 (CLINIC):
The following documents and supporting information are required by the Bureau of Fee-For-Service Programs to enroll your facility as a provider:

  • Completed provider enrollment application;
  • Signed outpatient provider agreement;
  • Copy of document generated by the Federal IRS that shows both name and tax ID of entity applying for enrollment;
  • A copy of the corporation papers issued by the Department of State Corporation Bureau;
  • Completed “Ownership or Control Interest” form;
  • Peer support services addendum (for Specialty 076 only);
  • Out-of-state providers – proof of home state Medicaid participation;
  • A statement signed by the medical director (licensed physician enrolled with PA Medicaid) indicating their affiliation with the clinic;
  • A copy of the medical director’s license; and
  • The medical director’s 13-digit PROMISe provider number.

For Specialties 558 and 808 through 811, include the service description denoting approval by the Bureau of Children’s Behavioral Health Services, Office of Mental Health & Substance Abuse Services (OMHSAS). Contact the Bureau at 717-705-8289 for additional information or requirements.

Often applications are received where the address of the facility license does not match the address on the provider application for enrollment or revalidation.

Make sure that the ownership and disclosure forms disclose at least one managing agent or person in charge. Many come in with no information and are returned to the provider.

Here is a link to a Q and A document regarding the ownership and control section of the application that may be helpful.

Anything related to the Behavioral Health HealthChoices counties – Managed Care Organizations should be directed to OMHSAS. Likewise, they continue to remind the BH-MCOs, if the provider is a state plan provider, they should be instructed to contact the appropriate program office for clarification/assistance to assure providers are being given the correct information.

RCPA wants to know about your experience with revalidation in Pennsylvania. Members may email Sarah Eyster with information. RCPA will continue to work closely with the licensing bodies to ensure timely review of programs in need of revalidation.

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