Revalidation
Federal regulations require state Medicaid agencies to revalidate the enrollment of all Medicaid providers once every five years (42 CFR Part 455). Instructions on when to revalidate and how to complete your revalidation can be found on this page.
On this page
Am I currently up for revalidation?
You will be notified by mail when you are selected for revalidation. No action is required until you receive the revalidation letter from HCA.
When selected for revalidation, a single letter is mailed to the group or facility being revalidated. Revalidation letters are not sent to individual providers working in a clinic.
The revalidation notice will be sent to the mailing address listed in ProviderOne. To ensure the revalidation notification reaches your office, please log into ProviderOne to confirm your mailing address is up-to-date.
Learn how to access ProviderOne.
I am a billing provider and received a revalidation letter. What am I required to do?
The revalidation notice you received will specify the requirements for the National Provider Identifier (NPI) listed on the letter. Complete all steps listed on the revalidation checklist that you received.
Deadline
You have 30 days from the date on the notice to provide the requested information. Your Medicaid billing privileges will be affected if you do not provide the requested information by the deadline; this includes your billing privileges under managed care entities and behavioral health organizations.
Billing providers must complete the following revalidation steps:
For assistance with the revalidation process, see the revalidation FAQ.
- Login to ProviderOne and click on Manage Provider Information. This link will take you to the Business Process Wizard (BPW) where you will need to review, update the information we have on file and upload required documents. For assistance with the BPW, see our step-by-step instructions.
- Important: You must submit updated disclosures of ownership, managing employees, and other controlling interests during Step 4 of the ProviderOne Business Process Wizard (BPW).
- Submit a signed Core Provider Agreement (form 09-015) and Debarment Statement (form 09-016).
- Submit an Internal Revenue Service (IRS) W-9 form.
- Submit additional required documents*. Certain provider types must submit additional materials. Be sure to submit all that apply to your provider type. Below are the most common:
- Copy of business license
- Copy of current Clinical Laboratory Improvement Amendments (CLIA)
- Copy of current hospital license
- Copy of current professional license
- Copy of current pharmacy license
- Trading Partner Agreement
- Copy of current ambulance license
- DMEs must be Medicare certified
* Please review the full list of required documents by provider type to see if any other documents pertain to you.
How do billing providers submit the required documents?
Download our instructions for how to upload attachments in ProviderOne. These instructions may only be used by billing providers.
I am a nonbilling provider and received a revalidation letter. What am I required to do?
The revalidation notice you received lists the National Provider Identifier (NPI) that is due for revalidation.
Deadline
You have 30 days from the date on the notice to provide the requested information. Your Medicaid billing privileges will be affected if you do not provide the requested information by the deadline; this includes your billing privileges under managed care entities and behavioral health organizations.
Nonbilling providers must complete the following revalidation steps:
- Individual nonbilling providers must complete the Individual Nonbilling form (PDF).
- Nonbilling groups, facilities, agencies, organizations, and institutions must complete the Organizational Nonbilling form (PDF).
Submit additional required documents*. Certain provider types must submit additional materials. Be sure to submit all that apply to your provider type. Below are the most common:
- Copy of business license
- Copy of current Clinical Laboratory Improvement Amendments (CLIA)
- Copy of current hospital license
- Copy of current professional license
- Copy of current pharmacy license
- Trading Partner Agreement
- Copy of current ambulance license
- DMEs must be Medicare certified
* Please review the full list of required documents by provider type to see if any other documents pertain to you.
How do Nonbilling providers submit the required documents?
Nonbilling providers do not have access to ProviderOne and must submit required documents to Provider Enrollment or by faxing 360-725-1259.
What is the difference between a billing provider and a nonbilling provider?
Nonbilling providers
provide services to Apple Health (Medicaid) clients under a Managed Care Entity or Behavioral Health Organization or if enrolled for the sole purpose of ordering, referring, prescribing provider, as well as individuals who are enrolled for their nonbilling provider identifier to be identified on hospital services claims
Billing providers
Provide services under the fee-for-service (FFS) Apple Health program
I provide services to clients under both a managed care entity and also the fee-for-service (FFS) program. Am I considered a nonbilling provider or a billing provider?
If you provide services under the fee-for-service (FFS) Apple Health program and also a managed care entity or behavioral health organization, then you are a billing provider and must follow the billing provider revalidation instructions.