CMS Pub. 100-08, ch. 10, § 10.4.5.1

A. Background

Under previous practice, CMS identified the providers and suppliers required to revalidate

during each cycle. CMS communicated when new lists became available through the

appropriate channels, at which time the contractor obtained the list from the CGI Share Point

Ensemble website. With the advent of PECOS 2.0, PECOS will automatically: (i) determine

when a provider/supplier is due to periodically revalidate its enrollment; and (ii) send a

revalidation notice to the provider/supplier. Note that this new process of revalidation

solicitation applies both to providers/suppliers that currently submit applications via (or

otherwise utilize) PECOS or via paper. For the former group, solicitations will be sent via the

PCV. For the latter, solicitations will be e-mailed via PECOS, and the affected provider/supplier

may submit its revalidation application via paper; it is not required to use PECOS.

B. Sending Revalidation Letters

Based on the due date identified in PECOS, PECOS will send a revalidation notice (using the

applicable letter in section 10.7 et seq. of this chapter) between 90 to 105 days prior to the

provider/supplier’s revalidation due date. The initial revalidation letter will include a generic

provider enrollment signature.

C. Interaction with Change Request

If the contractor receives a change of information (COI) application from the provider after

PECOS has mailed to the provider a revalidation notice, the contractor shall process it as a COI

with no merger of the two applications; the applications shall be processed separately.

If the provider submits an application marked as a revalidation but that only includes enough

information to be considered a COI, the contractor shall (1) develop for a complete application

containing the missing data elements and (2) treat it as a revalidation.

D. Interaction with a Change of Ownership (CHOW)

PECOS will not commence revalidation action regarding a provider/supplier that is undergoing a

CHOW that: (1) the contractor is currently processing; or (2) is pending review with the state

agency.

E. Reassignment Applications Received After Revalidation Letter Mailed

If a reassignment application has been received after a revalidation letter has been sent to the

affected provider/supplier, the contractor shall process the reassignment application. The

supplier need not report the newly established reassignment/employment arrangement on the

revalidation application, and the contractor shall not develop for this information; this is because

the arrangement was established after the revalidation notice was issued. However, the

contractor shall maintain the reassignment/employment arrangement information in the

enrollment record when processing the revalidation application; this information shall not be

overridden. If the supplier fails to respond to the revalidation request, all reassignments shall be

end-dated, including the newly established reassignment. Consider the following illustration:

EXAMPLE: Dr. Doe submits a reassignment application to add a new reassignment to Browns

Medical Center after receiving a revalidation request. He submits his revalidation application to

his contractor but does not include the reassignment for Browns Medical Center because the

contractor is still processing the reassignment application and has not yet approved the

reassignment. The contractor finalizes the reassignment changes and then proceeds with

processing the revalidation application. The contractor shall not develop for the new

reassignment to Browns Medical Center and shall maintain the reassignment in the provider’s

enrollment record when processing the revalidation application.

F. Revalidation Extension Requests

The contractor shall only accept extension requests from a provider that was not given the full 7

months’ advance notice prior to their revalidation due date. The contractor shall not accept

extension requests from providers for any other reason.

The provider/supplier may submit its request in writing (fax/e-mail/PCV permissible) or via

phone, though the individual provider, authorized/delegated official, or appropriate contact person

shall make the request. (See section 10.3 of this chapter for information regarding contact

persons for PECOS applications.)

G. Additional Letter Data

In addition to the PCV e-mailing revalidation correspondence, the contractor – in any

circumstance required per this chapter -- shall print and mail the following PCV-generated

letters: (1) revalidation notification letters (e.g., the first letter came back as undeliverable (see

subsection (B)(2) above)); (2) stay of enrollment letters; and (3) deactivation letters.

(NOTE: As a general rule, the PCV can, among other things: (1) automatically send emails (e.g.,

revalidation); (2) send e-mails upon request (e.g., development); (3) generate letters/store letters;

(4) send letters to a print queue; and (5) accept document uploads,)