What is provider revalidation in Medicare or Medicaid?

Provider revalidation is the periodic renewal and re-screening of an existing enrollment record to confirm that provider information remains accurate and enrollment requirements continue to be met. Medicare and Medicaid both use revalidation, but schedules and procedures differ by program and provider type.

Revalidation is the process of renewing and re-screening an existing provider enrollment record.

For Medicare, current CMS guidance states that providers and suppliers generally revalidate every five years, while DMEPOS suppliers generally revalidate every three years. CMS may also request off-cycle revalidation.

Revalidation can involve reviewing enrollment information, updating changes, submitting supporting documents, completing screening requirements, and confirming ownership or practice information.

Medicaid programs also require provider revalidation under federal screening and enrollment rules, but the operational process is administered by the state and can vary.

Failure to complete revalidation timely can interrupt billing privileges. Credentialing teams should maintain a revalidation calendar and monitor official notices rather than rely only on reminders.

• Revalidation renews an existing enrollment record.
• Medicare generally uses five-year revalidation for providers and suppliers and three-year revalidation for DMEPOS suppliers under current CMS guidance.
• Off-cycle revalidation can occur.
• Medicaid revalidation is state-administered within federal requirements.
• Missed revalidation can interrupt billing privileges.

A practice overlooks a Medicare revalidation due date. The provider’s billing privileges are deactivated, causing claims to stop paying. The credentialing team must complete the required enrollment action and investigate the impact on services rendered during the inactive period.

• Treating revalidation as optional.
• Waiting only for reminder letters.
• Assuming Medicare and Medicaid use identical schedules.
• Failing to update outdated enrollment information during revalidation.

Use current program-specific language and avoid giving a universal revalidation interval for every payer.