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Revalidating medicare enrollment

Additionally, OMIG recommends a regular visit to its website to review the information and resources that are published under the Compliance tab on OMIG's homepage.

The Compliance Library under the Compliance tab provides copies of current forms, publications and other resources that are helpful in conducting a self-assessment and completing the certification form in December.

The certification must occur in December of each year.

OMIG has actively enforced Social Services Law §363-d and Part 521 of Title 18 of the New York Codes, Rules and Regulations since 2009.

The Department of Health received approval from the Centers for Medicare and Medicaid Services (CMS) to amend the State's Medicaid Plan to effectuate the Community First Choice Option (CFCO) as of July 1, 2015.

CFCO will incorporate enhanced services and supports into the Medicaid State Plan for eligible individuals who need assistance with everyday activities due to a physical, developmental or behavioral disability.

Certifying in December and retaining a copy of the Certification Confirmation and/or confirmation emails will help Medicaid required providers complete the revalidation process.

42 USC §1396a provides in relevant part that: (a) A State plan for medical assistance must — (68) provide that any entity that receives or makes annual payments under the State plan of at least ,000,000, as a condition of receiving such payments, shall — (A) establish written policies for all employees of the entity (including management), and of any contractor or agent of the entity, that provide detailed information about the False Claims Act established under sections 3729 through 3733 of title 31, United States Code, administrative remedies for false claims and statements established under chapter 38 of title 31, United States Code, any State laws pertaining to civil or criminal penalties for false claims and statements, and whistleblower protections under such laws, with respect to the role of such laws in preventing and detecting fraud, waste, and abuse in Federal health care programs (as defined in section 1320a-7b(f) of this title); (B) include as part of such written policies, detailed provisions regarding the entity's policies and procedures for detecting and preventing fraud, waste, and abuse; and (C) include in any employee handbook for the entity, a specific discussion of the laws described in subparagraph (A), the rights of employees to be protected as whistleblowers, and the entity's policies and procedures for detecting and preventing fraud, waste, and abuse; OMIG addresses this mandate by monitoring providers' annual DRA Form performance and by conducting reviews of providers' compliance with the DRA requirements during a review.

The certification form and Frequently Asked Questions (FAQs) will be available on the OMIG website.

To avoid interruption of claims payment, providers must revalidate immediately.

If you have additional questions about revalidation, please call the e Med NY Call Center at 800-343-9000, option 2 or contact via e-mail at [email protected] with the subject "FINAL REVALIDATION NOTICE".


  1. SCOPE OF WORK Page 5 of 61 data using one centralized interface, whether the provider is enrolling or revalidating, for all agency supported programs.

  2. The Centers for Medicare & Medicaid Services CMS recently entered into a second cycle of provider enrollment revalidation. There are several tools on the CMS.

  3. New York State Medicaid Update - July 2015 Volume 31 - Number 8 In this issue All Providers. NY Medicaid EHR Incentive Program Update; Continued.

  4. CMS urges you to use internet-based PECOS for responding to the request for revalidation. downloads section on the CMS Medicare Provider/ Supplier Enrollment.

  5. Step 1 Determine You Are in the Right Place. Medicare provider enrollment revalidation is part of the Patient Protection and Affordable Care Act, Section 6401a.

  6. All providers and suppliers who enrolled in the Medicare program prior to Friday, March 25, 2011, will be required to revalidate their enrollment by March 25, 2012 under new risk screening criteria required by the Affordable Care Act section 6401a. Newly-enrolling and revalidating providers and suppliers are placed

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