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In compliance with the Affordable Care Act and 42 CFR 455, Subpart E, and as a part of the provider registration process, all providers registered with AHCCCS are required to revalidate enrollment at least every 5 years.
Forms can be located at: http://www.azahcccs.gov/PlansProviders/NewProviders/packet.html
Q. What is Revalidation?
A. Revalidation is a process requiring the State Medicaid Agency to complete a full screening appropriate to the provider’s risk level. Revalidation includes the disclosure requirements specified in 42 CFR § 455.104; 455.105 & 455.106, and, depending on the provider’s risk level, include a site visit and Fingerprint-Based Criminal Background Checks (FCBCs). Visit AHCCCS Medical Policy Manual (AMPM) Chapter 600, Provider Qualifications and Provider Requirements for screening requirements.
Q. How is it determined a provider is due for Revalidation?
A. Revalidation is determined by the original enrollment date, if enrolled or revalidated, prior to January 1, 2014.
Q. How is the provider notified when it’s time to revalidate?
A. The provider will receive two notices instructing the provider to submit specific revalidation documents. The notification is mailed to the most recent “Correspondence” address on file with AHCCCS for the provider through the United States Postal Service.
Q. Is there an enrollment fee associated to the completion of Revalidation?
A. This depends on the provider type. Refer to the “Required Fee and/or Site Visit by Provider type” link.
Q. Will the provider receive a separate notice if required to submit an enrollment fee or fingerprint card?
A. Yes, the provider will receive a separate notice requesting the enrollment fee or fingerprint card; notice will communicate specific timeframe(s) to respond.
Q. How long does the provider have to complete the Revalidation forms?
A. The provider has 45 days from the date of the initial request. The provider will receive 2 notices requesting the completion of revalidation. The initial request allowing 30 days from date of notice to respond; a second request once the 30 days has expired, notifying the provider they have 15 days to respond before the provider id is terminated.
Q. If the “Correspondence” address is updated after the initial revalidation request has mailed will the second notice be mailed to the new address?
A. Yes, as long as the “Correspondence” address was updated before the second notification has mailed.
Q. Who can complete the Revalidation forms?
A. The requirements for completing the forms have not changed. The enrolled provider is responsible for completing the appropriate revalidation forms; this task may be delegated to an authorized signer. Authorized signers are identified at the time of registration or by submitting a written request that contains the enrolled provider and authorized signer’s signatures, as well as, an effective date of the appointed authorized signer. If an authorized signer hasn’t been appointed by the enrolled provider, the responsibility of signing belongs to the enrolled provider. The following are individuals that can sign on the behalf of an enrolled institution and/or entity provider types (including group billers): CEO, CFO Administrator, Owner, Executive Director, President or Vice President.
Q. Can a provider submit the Revalidation forms prior to receiving the Revalidation request?
A. No, providers must wait to receive the revalidation notice.
Q. What happens if no response is received to the Revalidation request(s)?
A. The provider id will terminate, Medicaid billing privileges & access to the AHCCCS Online Portal will be deactivated.
Q. What is the next step if the provider id is terminated?
A. The provider will be required to submit a complete provider enrollment application for reactivation of the provider id.
Q. Is the provider notified when the Revalidation application has been completed?
A. Yes, the provider will receive a Revalidation completion letter. The notification will serve as documentation that the Revalidation process has been completed.
Q. Who should the provider contact for additional questions regarding Revalidation?
A. The AHCCCS Provider Enrollment Section:
Q. What are the available methods to submit Revalidation documents?
A. Fax, Mail, or Walk-in.