The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate provider enrollments at intervals not to exceed every five years. The CMS revalidation requirement for durable medical equipment (DME) and home medical equipment (HME) providers, including pharmacy providers with DME or HME specialty enrollments, is more frequent, at intervals not to exceed every three years.
Indiana Health Coverage Programs (IHCP) providers will receive notification letters when it is time to revalidate their enrollments. Notifications with instructions for revalidating are sent 90 and 60 days in advance of the revalidation due date. Notices are mailed to the mail-to address indicated on the provider's service location profile. Providers will also see a reminder on the home page of their Provider Account in the IHCP Provider Healthcare Portal (Portal). Providers with multiple service locations must revalidate the enrollment of each service location and will receive notification for each separately. Providers should not attempt to revalidate until they receive their notification letter.
Providers that fail to revalidate in a timely manner will be disenrolled from participation in the IHCP. After disenrollment, the provider will need to re-enroll with the IHCP. Disenrollment with subsequent re-enrollment may result in a gap in the provider's eligibility.
See Provider Enrollment Revalidation Due Dates through December 2020 for a list of providers with upcoming revalidation due dates.
How to Revalidate an Enrollment
Before beginning the revalidation process, providers should:
- Review the IHCP Provider Enrollment Type and Specialty Matrix to determine supporting documentation requirements based on provider type.
- Review the IHCP Provider Enrollment Risk Category and Application Fee Matrix to determine the screening criteria that apply to their provider specialty during revalidation and to determine whether an application fee is required. Providers subject to an application fee are required to pay the fee at the time of revalidation.
The IHCP encourages providers to use the Portal to revalidate enrollment. The Portal process is faster because much of the provider's information prepopulates. Online help walks providers through the revalidation process, and required documentation can be uploaded and submitted electronically. For group providers, documentation includes a current signed copy of the IHCP Rendering Provider Agreement for each rendering provider linked to the group's service location at the time of revalidation,
Providers that choose to revalidate on paper must use the appropriate IHCP provider packet - the same as is required at initial enrollment. There is not a separate revalidation form. To revalidate using paper forms:
- Find the appropriate IHCP provider packet by going to Complete an IHCP Provider Enrollment Application on this site and select the link associated with your provider type.
- Select the IHCP provider packet indicated for your provider classification and carefully review the instructions.
- Indicate "Revalidate Enrollment" in field 1 on Schedule A, under Type of Request. Complete all other fields in the packet, attach the required documentation, and mail the packet to the address indicated.
- Revalidation requires providers to complete all applicable information fields. It is not an update for which only additions, deletions, or changes are required.
- Group providers do not need to complete new rendering provider packets during revalidation. To revalidate the rendering providers linked to the group's service location at the time of revalidation, the group must submit a list of those rendering providers, including the information outlined in the instructions, as an attachment to the group packet. In addition, a current signed IHCP Rendering Provider Agreement must be included with the group's revalidation packet. (Disregard the IHCP Rendering Provider Enrollment and Profile Maintenance Packet at the end of the group provider packet, except for the IHCP Rendering Provider Agreement that can be copied for use.)
Regardless of submission format (Portal or paper) a current signed IHCP Rendering Provider Agreement for each active rendering provider linked to the group must be submitted with the group's revalidation packet.
Revalidation requirements also apply to ordering, prescribing, or referring (OPR) providers. See the Ordering, Prescribing, or Referring Providers page on this site for more details about OPR providers.
Revalidation of enrollment is not the same as recertification of enrollment credentials. See Recertify Provider Enrollment Licenses and Other Certifications on this site for details about the recertification process.
For more information about provider enrollment revalidation, see the Provider Enrollment provider reference module.