Check out this Quick Consult from PAMED for more information on Medicare and Medicaid revalidation.

If you haven’t revalidated for Medicaid yet, the time for Medicaid revalidation is now.

Pennsylvania physicians who enrolled in Medicaid on or before March 25, 2011 must revalidate by March 24, 2016. As required by the Affordable Care Act, DHS must re-validate (re-enroll) all providers at least every five years.

Pennsylvania’s Department of Human Services (DHS) sent a message to its stakeholders on Jan. 7, strongly encouraging providers to submit their revalidations applications as soon as possible.

DHS says that 67 percent of service locations have been revalidated as of Jan 7. While progress is being made, there are still many service locations that have yet to revalidate.

Providers are urged to review all of their service locations in PROMISe. If there are service locations listed that are no longer applicable, now is the time to close them so that DHS can remove them from their list of those still needing revalidation. To close service locations, providers should follow the instructions on the Enrollment Information webpage.

What does this mean for physicians and other health care providers?

There will be no retroactive payment for services provided during a deactivated enrollment period. Revalidating now will prevent any interruption in your participation in and payment from DHS or partnered managed care plans.

Submitting an Enrollment Application

Enrollment applications may be submitted in one of three ways, unless otherwise specified in the application instructions:

  1. Email:
  2. Fax: (717) 265-8284
  3. Mail: DHS/OMAP/BFFSP, Attention Provider Enrollment Unit, PO Box 8045, Harrisburg, PA 17105-8045

Physician and physician group applications can be downloaded from DHS’ enrollment information web page. Providers will need to complete a full new enrollment application for their provider type for each service location. Once a completed application is submitted, DHS will conduct the required screening.

You may have already revalidated and DHS encourages providers to check the MA Enrolled Provider Portal Lookup Function to determine your revalidation date. All provider letters and portal login screens contain your next revalidation due date. Look for changes on the provider portal for each 13-digit logon to check your service location(s).

The re-enrollment date will be displayed in the masthead of the provider portal for each service location. This is also the current expiration date for that service location based on the most recent application on file with DHS.

Questions? Contact the DHS Program Office at 1-800-537-8862 with any questions or concerns. Members of the Pennsylvania Medical Society (PAMED) also can contact our PAMED’s Practice Support Team at (717) DOC-HELP (717-362-4357).