10/10/2016

Revalidation Required for Medicaid Enrollment

The federal regulation 42 CFR 455.414 requires providers to revalidate their enrollment with the New York State Medicaid Program. Providers have already received individual written reminders to revalidate, although thousands of providers have not done so. The deadline for submission of revalidation packages was September 25, 2016. 

Effective for eMedNY claims processing starting October 27, 2016, all claims from non-revalidating billing providers will be pended until the provider’s revalidation package is received. To avoid interruption of claims payment, providers must revalidate immediately.

To revalidate:
     1. Visit the Provider Enrollment page at emedny.org/revalidation, Locate your enrollment form and additional required documentation, and determine whether an enrollment fee is required. There is a slide presentation, step-by-step processes, and an FAQ section. These resources provide important information on the revalidation process.
     2. Complete and mail the appropriate form(s) with all required documentation to the address provided. Keep a copy of the forms and documentation.

Next steps:
     1. Allow 2 to 3 weeks for the receipt and processing of the revalidation packet by eMedNY.  Once your completed revalidation is received and processed, all claims that have been held due to missing or late revalidation will be released for processing during that cycle. 
     2. If more than 3 weeks have passed since sending the revalidation to eMedNY, please contact providerenrollment@health.ny.govwith the subject “FINAL REVALIDATION NOTICE” and provide all pertinent information regarding your submission, such as the date you sent it, and the address you sent it to so that we can research it.
     3. The remittance message for these pended claims is: Health Claim Status Code: 46 INTERNAL REVIEW/AUDIT

If you have additional questions about revalidation, please email providerenrollment@health.ny.gov with the subject “FINAL REVALIDATION NOTICE”, or call the eMedNY Call Center at 800-343-9000 Option 2.