Provider Revalidation

 

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 providers actively enrolled with Montana Healthcare Programs who have not had a revalidation request in the last five years. Providers who are required to complete revalidation will be mailed a Revalidation letter.

On December 13, 2021, Montana Healthcare Programs began sending revalidation request notices to providers. The letters specify a due date. Montana Healthcare Programs is extending the required revalidation date to June 2022 for any provider who has received a revalidation notice. This extension is due to the challenges presented by learning a new provider enrollment and maintenance system, in addition to the significant volume of providers requiring revalidation.

 

Steps to Complete Revalidation

If you have not already registered for the Provider Services Portal, please follow the steps in chapter 2 of the Provider Services Portal User Guide to register and set up your user access for the Provider Services Portal. 

Please log in to the Provider Services Portal to complete the revalidation process following the steps below: 

  • Click Provider Enrollment tab under myMenu.
  • Search for the NPI.
  • Click Radio button at the beginning of the enrollment line.
  • Click the Revalidate tab, now visible under the Enrollment menu.
  • Click Pencil icon on the revalidate line, located at the end of your current work bench list.
  • Review the information and enter/update any missing or incorrect information upload documentation as applicable and Submit.

Note: Providers must be linked before you can view the provider in your work bench.

 

MPATH Provider Services Portal Link Request Form Instructions

Click on the blue Complete request form button

Section 1 enter the NPI & name you registered with.
Section 2 enter the NPIs you want to link.
Sections 3 & 4 enter the submitter’s information.

Once completed, upload the form for processing using the Upload Request button. Allow 10 business days for processing. The Status will change from Submitted to Completed, when processed

 

If you have any questions, please call Provider Services at 800-624-3958, or email us at MTPRhelpdesk@conduent.com.

Why do I need to revalidate?
In order to comply with the Patient Protection and Affordable Care Act, Section 6401 (a) and 42 CFR 424.515, Montana Healthcare Programs now requires all actively enrolled providers and suppliers to revalidate their enrollment information every three to five years, depending on provider type.

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 fax or mail in my provider information instead of submitting online?
Revalidations must be completed through our Provider Services Portal. We are unable to process revalidations submitted by fax or mail. If you are unable to upload a document to the portal, you may mail it so it can be attached to your online file. Please include your NPI/PID and mail it to:
PO Box 89
Great Falls, MT 59403

Who is required to revalidate?

  • All providers, regardless of provider type are required to revalidate every three to five years
  • All providers who have received a revalidation notice

When do I need to complete my revalidation?
A due date is provided in your Revalidation Request letter, this date is within 60 days of the date your letter was sent to you. We request you submit your revalidation within 30 days to allow us time to process your file prior to the deadline. As of 2/17/2022, the deadline has been extended to June 2022.

What happens if I do not complete my revalidation within the required timeframe?
Providers who do not complete their revalidation within the required timeline will have their claims processing suspended until the revalidation is completed. Once the revalidation is completed, claims processing will resume.

What if I have received a revalidation request but no longer want to be enrolled with Montana Healthcare Programs?
You can disenroll online through our Provider Services Portal.

What if I received a revalidation letter for an individual provider who no longer works for our facility?
You can disenroll that provider online through our Provider Services Portal.

Am I required to pay an application fee with my revalidation?
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.

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. Revalidations will be rejected if this information is not correct or complete.

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

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. In this case, 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 revalidation by the specified deadline. You have 30 days from the date of the suspension letter to complete your online revalidation.