The notice went to the wrong address
MAC letters go to the correspondence address in PECOS. If nobody updated it after a move, the first sign of a problem is a wall of denials.
Provider credentialing
Medicare Revalidation Services
Medicare requires every enrolled provider and group to revalidate on a fixed cycle. We monitor the due date for every NPI on your roster, complete the revalidation in PECOS, and answer the MAC before your billing privileges are at risk.
120 dayshead start on every due date
Every NPIindividual and group records monitored
Zerodeactivations from missed deadlines is the goal
Revalidation at a glance
- Physicians and NPPs: every 5 years
- DMEPOS suppliers: every 3 years
- Due dates posted by CMS up to 6 months ahead
- Missed deadline means deactivation
- We start 120 days before the date
The application path we run for this payer
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
Physicians and non-physician practitioners revalidate every five years; DMEPOS suppliers every three. CMS posts the due date on its lookup tool and the MAC sends a notice, but that notice goes to the correspondence address on file, which in many practices is an old office or a former manager's inbox.
A missed revalidation does not generate a warning. Billing privileges are deactivated, claims start denying, and re-enrollment can mean a gap in the effective date that is never recovered. ClainetRCM watches the due date for every provider and group and finishes the revalidation early.
Where this usually goes wrong
Group and individual cycles differ
The group's 855B and each provider's 855I revalidate on separate schedules. Practices that track one and forget the other still get deactivated.
Development requests during revalidation
A revalidation is a full review of the record. Old ownership data, closed locations and expired licenses all surface as development requests with short deadlines.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- Revalidation due date lookup for every individual and group NPI
- Correspondence address correction so notices reach the right person
- Full record review and cleanup before the revalidation is filed
- CMS-855I and 855B revalidation completed in PECOS
- Development request responses within one business day
- Confirmation letters filed and next cycle date calendared
Revalidation cycles and what happens when they are missed
| Physicians and NPPs | Every 5 years. Includes MDs, DOs, NPs, PAs, therapists, psychologists and other individually enrolled practitioners. |
|---|---|
| Group practices and clinics | Every 5 years on the group's own cycle, separate from each member's individual cycle. |
| DMEPOS suppliers | Every 3 years. See DME Medicare enrollment. |
| Off-cycle revalidation | CMS can request revalidation at any time, often after an ownership change or a program integrity review. |
If the due date passes, the MAC deactivates billing privileges. Reactivation requires a new full application, and the gap between deactivation and reactivation is generally not billable. That is the outcome we exist to prevent.
Questions about Medicare Revalidation
CMS publishes due dates on its revalidation lookup tool, listed by NPI, up to six months ahead. Providers not yet due show as TBD. We check every NPI on your roster monthly and start the revalidation as soon as a date appears.
You can submit once the due date is posted, generally up to six months in advance. Submitting before a date is posted is treated as an unsolicited application and can be rejected, so timing matters.
You will need to file a new enrollment application, and the effective date is generally the date the new application is received, not the original date. We move quickly to limit the gap and make sure the reactivation is complete. See Medicare provider enrollment.
Individual practitioners do not pay an application fee. Institutional providers, groups in some categories and DMEPOS suppliers pay the CMS application fee at revalidation. We tell you in advance which fees apply.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicare Provider Enrollment Services
CMS-855 applications and PECOS filing
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
PECOS Enrollment and Account Management
Medicare's online enrollment system
Insurance Credentialing Services
Commercial and government panels, end to end
Provider licensing
Licenses that must be current before revalidation
Hospitals and health systems
Large rosters with staggered cycles
Credentialing revenue impacts
What lapses actually cost
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.