MCO/BHO Provider Enrollment/Revalidation FAQ
Learn the answers to frequently asked questions about Medicaid
Revalidation is required for all currently enrolled Medicaid providers (those with a Medicaid ID). MCO/BHO providers that are enrolled in Medicaid as well as credentialed into a plan network must complete the revalidation process.
MCO/BHO and CHP+ network providers who are currently not enrolled in Medicaid must complete enrollment no later than October 31, 2016. Although the Centers for Medicare and Medicaid (CMS) has extended its deadline for provider revalidation to September 24, 2016, it is critical that Colorado providers complete revalidation and/or enrollment as soon as possible. The Department is launching its new enrollment and claims management system, the Colorado interChange, on November 1, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied. Questions regarding provider revalidation and enrollment should be addressed to Provider.Questions@state.co.us. Please be patient, as response time may run 10-14 days.
Frequently Asked Questions
1. What is the purpose of this initiative?
New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers. Beginning Sept. 15, 2015, all Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to enroll and revalidate their licensure and business information under new federal enrollment screening criteria. The Department of Health Care Policy and Financing (HCPF) has posted more information on the provider screening rule on their website; click on the Federal Provider Screening Regulations link.
2. With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes?
With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes? Current providers will continue to use their Medicaid ID numbers through October 31, 2016. Starting on November 1, all Medicaid and CHP+ providers will be identified in the interChange system either by their NPI or by a system-assigned ID number (for providers not eligible for an NPI). Providers identified by a system-assigned number will be notified shortly before full implementation, hopefully by mid-October. Current/existing Medicaid ID numbers will remain in the system as legacy identifiers but will not be used to pay claims with a DOS of 11/1/16 or later.
3. Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?
Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?” The Department is still working on an outreach plan for providers who have not revalidated within established time frames. A spreadsheet was distributed to MCOs/BHOs in mid-January 2016 that listed providers, by county, who had not started revalidation by 12/31/15. MCOs/BHOs should compare this list to their list of network providers that are currently enrolled in Medicaid. An updated list will be provided by the end of February 2016. These providers should be outreach targets. Providers will be notified by the interChange system several months prior to their next revalidation period, which will be either 3 years or 5 years, depending on provider type.
4. Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?
Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?” Not at this time. Providers will be notified of their next required validation.
5. Will there be a list of validated providers available to the plans?
The Department is able to pull a list of providers who have revalidated by NPI number, but cannot pull a list of providers by health plan.
6. We understand providers will get a confirmation letter when they’re revalidated. Can the plans get a copy of this letter template?
The current letter is being revised and a new letter with additional information will be published in the near future. We will provide a copy of both letters. The date for distribution of the new letter is still pending.
7. Can the Plans be a cc on the letter to the providers?
No. Letters are sent directly to the email address submitted by the provider in its revalidation application. A costly systems change would be required to include a cc for health plans in these letters.