Revalidation: Stakeholder Toolkit

Outreach materials for advocates and stakeholders to remind Medicaid providers about revalidating their enrollment.

Customize these tools in communications to your members and colleagues.

The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate all actively enrolled Medicaid providers at least every five years. This requirement is for ALL Medicaid providers.

As a result of the COVID-19 Public Health Emergency (PHE), revalidations that were due in calendar year 2020 were paused. Starting on September 3, 2024, all providers will be required to revalidate based upon their enrollment date. Failure to revalidate will result in the provider being removed from Medicaid. When removed, providers will NOT be able to bill for some of their most vulnerable patients and clients.

Providers will receive a revalidation notice 90 calendar days prior to their Illinois Medicaid Enrollment end date and a second notice will be distributed 30 calendar days prior to the Revalidation Cycle end date.

Many providers have never been through the revalidation process and others may need to be reminded about it. We are asking advocates and stakeholders to help us encourage providers to respond to their revalidation notices and complete the process.

For more information, visit the IMPACT web pages.

Participate in the “Stay Connected” campaign, a comprehensive effort to keep Medicaid providers enrolled. Below you will find materials you can tailor and include in communications to your networks.

Distribute them online, in emails and mailings, at conventions and conferences, during regular calls and meetings and any other touch points in the coming months.

The main talking points to convey to Medicaid providers:

• Following a pause during the Covid PHE, regular mandated revalidation is being resumed to comply with rules of the Centers for Medicare & Medicaid Services (CMS). These rules require that state Medicaid programs revalidate all actively enrolled Medicaid providers at least every five years.
• Revalidation notifications are sent 90 days before the provider’s due date. For example, the first group of notifications is targeted to start on September 3, 2024; these will be due in November 2024.
• The revalidation cycle:
  • Will occur for a new group of providers each month
  • Is based upon the provider enrollment date.
    • A provider’s revalidation due date can be found on the basic information page of their enrollment.
• An explanation on how to complete the process will be given to providers with their notices. The process includes reviewing their current enrollment information and updating as needed.
• Failure to revalidate will terminate providers from the Medicaid Program, meaning:
  • All payments will cease for any services provided beginning the day after the revalidation due date.
  • It is imperative revalidation is completed timely as retroactive reinstatements are not allowed, in accordance with federal regulations.
  • A provider may seek be revalidated after the due date, but if approved, payments can only date back to the new enrollment date. This would cause a gap in enrollment and eligibility for payment.
• When the revalidation cycle starts, materials will be emailed to providers
  • It is the provider’s responsibility to ensure all information contained in the IMPACT system is up-to-date and accurate
  • Step by step instructions and a Frequently Asked Questions document are available on the Impact Website to assist providers.
  • If providers need further assistance in completing revalidation, Provider Enrollment call center staff are available Monday – Friday 8:30 am – 5:00 p.m. at 877-782-5565.
  • A significant number of staff have been added to the call center to help with the potential volume.
• Providers can complete some preliminary work to prepare for revalidation, such as Okta sign-up, which we will explain as we reach out

Please use or edit these ‘Stay Connected’ templates and materials to meet your needs and specific audiences. To ensure consistency, try to adhere close to the original messaging. 

SMS:

Medicaid Providers: Watch your email inbox for revalidation notices, beginning Sept 2024. Revalidation is required to stay enrolled. Txt STOP=stop 

MMS [Add graphics]:

ALERT: Medicaid providers! You will need to revalidate your enrollment to stay in the program. Revalidation notices will be emailed beginning Sept 2024. Learn more at https://hfs.illinois.gov/impact.html and click ‘Provider Revalidation’. STOP = unsubscribe. 

[Print the 8-1/2 x 11 ‘Stay Connected’ one-pager flyer (PDF) and include it in mailings and emails. Or modify the language (Word) and put it on your letterhead for distribution.]

• Stay Connected one-pager flyer [PDF] 
• Stay Connected messaging [Word] 

[Print and cut the 8-1/2 x 3.6 ‘Stay Connected’ palm cards (PDF), which can be used in brochure stands or included as an envelope stuffer.

• Stay Connected palm card / stuffer [PDF] 

🚨 Medicaid provider revalidation alert 🚨

Medicaid providers: Watch your email inbox for revalidation notices from IMPACT, beginning in September 2024. Revalidation must be completed to stay enrolled in the Medicaid Program. Learn more at https://hfs.illinois.gov/impact.html

[Please use the language below to communicate by email or postal mail to your networks. If email, use subject: Medicaid Providers: Revalidate to stay enrolled. If possible, use preheader: Watch your email inbox for details.]

Dear NAME/PROVIDER,

Are you an Illinois Medicaid provider – and do you want to continue to be enrolled?

The Illinois Department of Healthcare and Family Services (HFS) has asked us to let Medicaid providers know that they will need complete a revalidation process to remain in the program. Providers who do not revalidate risk inactive status (termination) and may no longer receive payments for Medicaid services.

The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate all actively enrolled Medicaid providers at least every five years. This requirement is for ALL Medicaid providers. Revalidations that were due in calendar year 2020 were paused as a result of the COVID-19 Public Health Emergency (PHE), which means many providers have never revalidated and others have gotten out of the regular routine of revalidation. Revalidation notices will be sent in rolling stages beginning in September 2024. We encourage Medicaid providers to be on the lookout in your email inboxes for IMPACT revalidation instructions. Providers should also make sure to discuss revalidation with office support staff, especially those in billing who interact with HFS. Authorized representatives may complete the revalidation on behalf of a provider. Instructions for individuals and organizations are available here.

Currently enrolled Medicaid providers will receive two email notifications regarding their revalidation due date. The first notice will be distributed 90 calendar days prior to the revalidation cycle end date and the second notice will be distributed 30 calendar days prior to the revalidation cycle end date.

Providers who do not revalidate will be deactivated/terminated. If the provider decides to reactivate their Illinois Medicaid enrollment beyond the expired revalidation cycle end date, the provider will be given an effective date based on when the re-enrollment is submitted. This will create a gap in provider eligibility. Retroactive enrollment will not be granted which will result in claims being denied for the period of time the provider failed to complete revalidation. 

Note that even if a provider has revalidated their provider enrollment with Medicare, they must also complete the revalidation process with Illinois Medicaid.

For more information, visit the HFS IMPACT page and click on the “Provider Revalidation”.

Sincerely,

[Cut, paste and modify this language to include in future newsletters to your members.]

The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate all actively enrolled Medicaid providers at least every five years. This requirement is for ALL Medicaid providers. Revalidations that were due in calendar year 2020 were paused as a result of the COVID-19 Public Health Emergency (PHE), which means many providers have never revalidated and others have gotten out of the regular routine of revalidation.

Revalidation notices will be sent in rolling stages beginning in September 2024, HFS said. We encourage Medicaid providers to be on the lookout in their email inboxes for IMPACT revalidation instructions. Providers should make sure to discuss revalidation with office support staff, especially those in billing who interact with HFS. Authorized representatives may complete the revalidation on behalf of a provider. Instructions for individuals and organizations are available here.

Currently enrolled Medicaid providers will receive two email notifications regarding their revalidation due date. The first notice will be distributed 90 calendar days prior to the Revalidation Cycle end date and the second notice will be distributed 30 calendar days prior to the Revalidation Cycle end date.

Providers who do not revalidate will be deactivated/terminated. Should the provider decide to reactivate their Illinois Medicaid enrollment beyond the expired revalidation cycle end date, the provider will be given an effective date based on when the re-enrollment is submitted. This will create a gap in the providers eligibility and will result in claim payments being denied for the period after their eligibility ceases. These providers will not be eligible for retroactive enrollment. 

Note that even if a provider has revalidated their provider enrollment with Medicare, they must also complete the revalidation process with Illinois Medicaid.

For more information, visit the HFS IMPACT page and click on the “Provider Revalidation”.