CMS Pub. 100-08, ch. 10, § 10.4.5

Consistent with section 6401(a) of the Patient Protection and the Affordable Care Act (ACA), all

existing providers and suppliers are required to revalidate their enrollment information under

new enrollment screening criteria. Providers and suppliers are normally required to revalidate

their Medicare enrollment every 5 years (every 3 years for DMEPOS suppliers). However, CMS

reserves the right to perform off-cycle revalidations as deemed necessary.

Except as otherwise stated in this chapter or another CMS directive, the contractor shall follow

the guidance in sections 10.4.5 through 10.4.5.3 of this chapter when processing revalidation

applications. This guidance takes precedence over all other instructions in this chapter

concerning revalidation processing unless, again, another CMS directive specifies otherwise.

The contractor shall note, however, that some of the instructions in section 10.4.5 et seq. may not

apply to PECOS revalidation applications. This is because, as stated in section 10.3(C) of this

chapter:

(1) PECOS automatically handles revalidation tracking and revalidation requests and prevents

the submission of PECOS revalidation applications outside of the revalidation window.

(2) PECOS establishes timeframes and then queues mailings based on revalidation history and

enrollment dates (although CMS can modify timeframes and request off-cycle revalidations

at any time; this includes those for large group revalidations.) All PECOS revalidation

requests will be staggered so that revalidations are submitted and processed within 7 months

of the provider’s due date. This will eliminate the potential for unsolicited revalidation

applications submitted outside of the 7-month window and permit a more structured and

streamlined revalidation process.

(3) Failure to respond to a revalidation request would result in an automatic pend, deactivation,

etc.

Accordingly, the contractor can disregard those instructions in section 10.4.5 et seq. that

obviously do not apply to a particular situation.