Provider Revalidation

At HRX, we are dedicated to assisting medical entities with revalidation of Medicaid enrollment as required by the Affordable Care Act (ACA). Tracking revalidation is critical because it can affect your ability to provide Medicaid to patients. If your Medicaid enrolment lapses without revalidation, your claims may be denied. We ensure that revalidation is completed effectively and well within time to prevent undesirable consequences of a lapse.

What you need to know about Provider Revalidation

  • The Affordable Care Act (ACA) mandates the state to revalidate a medical practice's Medicaid enrolment every five years.
  • This requirement has been enforced by The Department of Health and Human Services (DHS) under 42 CFR 455.414(C).
  • Compliance with federal regulations and CMS guidance requires DHS to complete validation of enrolled providers. This can be done if providers submit applications to the DHS well in advance.

What happens if provider revalidation is not completed as expected?

If providers don't complete revalidation as mandated, the provider's claims can be denied following lapse of the date and the provider will be disenrolled from the Medicaid system.

As a client of HRX, you can entrust the responsibility of maintaining your Medicaid record and applying for provider revalidation well within the prescribed date.