Federal regulations within the Affordable Care Act (ACA) require state Medicaid agencies to revalidate the enrollment of all Medicaid providers once every five years. The Health Care Authority (HCA) implemented a Medicaid provider revalidation process starting in December of 2013.
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Federal regulations require us to revalidate the enrollment of all Medicaid providers every five years regardless of provider type (42 CFR Part 455).
You will be notified by mail when you are selected for revalidation. No action is required until providers receive the revalidation letter from HCA.
If you are up for revalidation you will be notified via letter. The revalidation notice will be sent to the mailing address listed in ProviderOne. To ensure the revalidation notification reaches your office, please login to ProviderOne to confirm your mailing address is up-to-date.
If you need assistance logging in to ProviderOne, please contact ProviderOne Security.
Yes, the provider revalidation process is a federal requirement that applies to all Medicaid providers, including those residing outside the state of Washington.
Revalidation letters will specify the requirements for the NPI listed on the letter. Included are requirements for all providers to:
- Submit updated disclosures of ownership, managing employees, and other controlling interests in the ProviderOne portal (required under the Code of Federal Regulations 42 CFR 455.104)
- Submit a signed Core Provider Agreement (form 09-015), Debarment Statement (form 09-016), and copy of current liability insurance.
- Submit an Internal Revenue Service (IRS) W-9 form.
- Other documents may be required specific to your provider type.
- Notifies providers by mail when a provider is selected for revalidation.
- Collects required documents, including:
- Core Provider Agreement.
- IRS W-9 form.
- Medicaid Provider Disclosure Statement
- Screens providers according to processes mandated by federal regulations (42 CFR 455.450). The screening includes:
- Federal database checks performed on providers, owners, managing employees, and controlling interests.
- May also include unannounced on-site inspections of provider locations.
- Verifies providers are in compliance with agency requirements for provider type. This includes:
- Verification of professional and business licensure.
- May include:
- Verification of certification requirements such as Medicare.
- Verification of Trading Partner Agreement on file.
- Other state regulated requirements.
Where are provider revalidation letters mailed?
When selected for revalidation, a single letter is mailed to the clinic being revalidated. Revalidation letters are not sent to individual providers working in a clinic.
Individual providers submitting claims directly to the agency as a part of a private practice are included in the revalidation process and receive a provider revalidation letter when selected for revalidation.