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Provider Revalidation

Provider Revalidation Instructions

Announcement: Revalidation and Faxes

Provider Relations has received concerns about an inability to get faxes submitted to the revalidation fax line, 406-457-9566.  If a provider is having trouble getting a fax through this line we suggest the following times to avoid the busy signal:
•    Mondays and Fridays are the lightest traffic
•    On any day, Early mornings and later afternoon are the best.  
•    The time to avoid is the 11 to 1 lunch hour

(posted 09/07/2016)

Thank you for your continued participation with Montana Healthcare Programs.

In order to comply with the Patient Protection and Affordable Care Act, Section 6401(a) and 42 CFR 455.414, Montana Healthcare Programs now requires all actively enrolled providers and suppliers to revalidate the enrollment information on file every three to five years, depending on provider type.

Currently the Montana Department of Public Health and Human Services (DPHHS) is revalidating provider enrollment for all providers actively enrolled with Montana Healthcare Programs during or prior to 2011. Providers who are required to complete revalidation will be mailed a Revalidation Packet between June and September 2016. While we appreciate those of you who have reached out in an attempt to be proactive, packets will only be sent out per the revalidation schedule.

The revalidation packet will contain data currently on file for each individual or group provider that must be reviewed and verified. An ownership disclosure form is also included and must be completed for each person/corporation with current ownership or current controlling interest in the provider or in any subcontractor in which the provider has direct or indirect ownership of five percent or more. The revalidation form containing needs to be signed, acknowledging the accuracy of the information and returned to Xerox in the allotted time frame specified in the Revalidation Packet. If the data is unchanged, simply check the appropriate boxes on the form, make sure the ownership is completed, assign a contact in case there are questions, sign and return.

  • Packets must be completed entirely -- For convenience, if the same ownership is true for multiple revalidations, please use the form here: http://medicaidprovider.mt.gov/Portals/68/docs/forms/ownershipproviderdisclosurestatement.pdf  Please do not substitute an ownership page from one revalidation for another.

  • Packets must be marked with an update or No Change. Columns left blank will be rejected and returned to the provider for correction.
  • If returning the packet by Fax, please use the designated fax number, 406-457-9566

If you received a notification letter or a packet for a provider that no longer works at your facility, please notify Provider Relations immediately in writing.

More information will be available on this page as the Revalidation effort moves forward. Please contact Provider Relations, 1-800-624-3958, option 6.

Please use the Ownership Disclosure form found for additional pages.  

A Sample Provider Revalidation Packet is available.

When the Revalidation Packet is complete, return the packet via Fax or Mail to:

FAX: Fax a copy of this completed packet and requested corrected documentation with cover sheet to 406-457-9566.

MAIL: Mail a copy of this completed packet and requested corrected documentation to Provider Relations, PO Box 4936, Helena MT 59604.

More information on the requirements of this CFR is available on the US Government Publishing Office Website.

 

Revalidation FAQs

Why do I need to revalidate?
Section 6401 (a) of the Affordable Care Act:

  • Established new screening requirements for new and existing providers/suppliers
  • Required all existing providers/suppliers to be revalidated under new screening requirements
  • Reinforces the revalidation requirements at 42 CFR §455.414

Is revalidation a full re-enrollment?
No. The revalidation effort focuses on specific elements of the provider file and is not a full enrollment.

Can I revalidate my provider information online?
No. There is not an online provider revalidation option at this time.

Who is required to revalidate?

  • All providers, regardless of provider type are required to revalidate every three to five years
  • Providers who are notified for the 2016 revalidation effort
  • All providers who have enrolled during or prior to 2011

When do I need to complete my revalidation?
A return date will be provided in your packet, this date is within 30 days of the date your packet was sent to you.  Early return of your revalidation packet via fax is appreciated!

How do I return my completed revalidation packet?

  • FAX: Fax a copy of this completed packet and requested corrected documentation with cover sheet to 406-457-9566.
  • MAIL: Mail a copy of this completed packet and requested corrected documentation to:

          Provider Relations
          PO Box 4936
          Helena MT 59604
 
What happens if I do not complete and return my revalidation packet within the required timeframe?
Providers who do not complete and return their revalidation packets within the required timeline will have the processing of their claims suspended and requires a response to the revalidation request for processing to resume.
 What if I have lost my original revalidation request packet?
Providers who need to request a new packet can contact Provider Relations at 1-800-624-3958, option 6

What if I have received a revalidation request but no longer want to be enrolled with Montana Healthcare Programs?
Contact Provider Relations in writing, requesting termination of your Montana Healthcare Programs participation.

What if I received a revalidation packet for an individual provider who no longer works for our facility?
Contact Provider Relations in writing notifying them this provider is no longer with you and they will process a termination of that provider’s Montana Healthcare Programs participation.

Am I required to pay an application fee with my revalidation application?
If applicable, you will need to pay the application fee or provide verification that you have paid the fee to Medicare or another state Medicaid program in order to complete the revalidation process. For more information about the application fee, go to: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareApplicationFee.html

           Surveillance Review Utilization Section
           Revalidation
           2401 Colonial Drive
           PO Box 202953
           Helena, MT 59620

Does ownership reflect the provider or the tax information?
Ownership pertains to the owner of the registered NPI number. If the provider is an individual, John Smith, the ownership should reflect John Smith and his identifying information.  It should not reflect the facility or organization John Smith works for. Packets will be returned if this information is not correct.

Do I have to disclose identifying information for all owners and managing employees?
Yes, this is a federal requirement. Packets will be returned if SSN and DOBs are not provided.

If I return only a signature page, will I be in compliance?
No. Packets must be completed entirely, with a change of information OR No Change clearly indicated, and all 4 pages returned to be considered complete.

If ownership is the same across multiple organization packets, can I substitute the ownership page of one packet into another packet so I don’t have to fill out the same information multiple times?
Each packet has unique identifying information and if the NPI, Provider Type and CRN do not match on all 4 pages it appears as if the ownership has been misplaced in the wrong packet.
If you have the same organization ownership for multiple packets you must cross out the NPI, Provider Type, and CRN on the on the copies from the original ownership page and write in the appropriate(CRN, NPI and Provider type)information for the provider packet you are attaching the copies to.
OR
Fill out the Ownership Update form found at the link below and include copies of that form with your revalidation :
http://medicaidprovider.mt.gov/Portals/68/docs/forms/ownershipproviderdisclosurestatement.pdf

We are a non-profit. Do we have to supply ownership information?
Yes. As noted in the instructions, Organizations must disclose two levels of ownership unless they can attest Company A has 100% controlling interest in Clinic X, for example. In the case of a non-profit, the organization generally owns themselves and then the board makes the decisions. So you will disclose the organization, and the CEO as the two levels of ownership, then the board as managing employees. This disclosure it is to ensure that no one connected with federal (Medicaid) dollars is on any exclusion list. As a dramatic example, if Al Capone was on your board and you weren’t aware of his being on an exclusion list, the organization would still be held accountable for his actions or denied participation if the information was not disclosed but was discovered by a state or federal entity.

If I receive a suspension letter, what does that mean?
It means Provider Relations did not receive your packet by the specified deadline. You have 30 days from the date of the suspension letter to return your completed packet. It is preferable if you return the packet to the fax or mailing address listed in the packet instructions. Your packet may encounter delays that could impact your deadline if returned using other methods.