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Welcome  » December 15, 2018 11:35 PM
Medicaid Provider Revalidation

ForwardHealth has changed the Medicaid provider revalidation process (formerly known as recertification) as part of its implementation of the Affordable Care Act requirements. The changes made to this process are effective for all revalidations completed on and after May 13, 2013.

Some of the changes include the following:

  • The provider revalidation process is almost completely paperless (similar to the initial enrollment process).
  • Providers are asked to provide additional information for persons with an ownership or controlling interest, managing employees, and agents.
  • Providers are subject to additional screening activities based on their risk level.
Revalidation Requirements

All Medicaid-enrolled providers are required to revalidate their enrollment information every three years to continue their participation with Wisconsin Medicaid. During the revalidation process, providers update their enrollment information and sign the Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation.

Provider Revalidation Notice

Providers receive a Provider Revalidation Notice in the mail from ForwardHealth when it is time to undergo revalidation. The Provider Revalidation Notice specifies the provider's revalidation date. Providers have 30 days from their revalidation date to submit their revalidation application.

Note: Providers will not be able to revalidate their enrollment prior to their revalidation date or after the 30-day deadline for revalidating.

Failure to Revalidate Enrollment

Providers who fail to submit their revalidation application by the deadline will be terminated from Wisconsin Medicaid. To reactivate Medicaid enrollment, the provider will be required to complete a new provider enrollment application and undergo additional screening activities. The provider may be required to pay another application fee.

Additional Information from Home Health, Personal Care Providers, and Prenatal Care Coordination Providers

As a reminder, home health, personal care agencies and prenatal care coordination workers are required to maintain certain personnel information on file with ForwardHealth. Home health, personal care providers and prenatal care coordination providers should update personnel information, as necessary, during the revalidation process; they should keep it current on an ongoing basis via the demographic maintenance tool on the Portal.

Establishing a Provider Portal Account

Providers who do not have a Provider Portal account will need to establish one in order to complete the revalidation process. Establishing a Provider Portal account involves submitting a request on the Portal and receiving a PIN letter in the mail, so providers who need to establish one are encouraged to do so as soon as possible to avoid delays in revalidating their enrollment.

For detailed instructions on establishing a Provider Portal account, providers may refer to the Account User Guide on the Portal User Guides page of the Portal.

Beginning the Revalidation Process

To begin the provider revalidation process, providers should follow these steps:

  • Select "Login" on this page or from the Portal Home page to log in to a secure Provider Portal account.
  • Enter the requested login information.
  • Once in a secure Provider Portal account, click on the Revalidate Your Provider Enrollment link and enter your National Provider Identifier or Provider ID, Social Security number, federal tax ID number, and ZIP code.
Checking the Status of Revalidation

After submitting the revalidation application, providers may check on the status of their revalidation at any time by logging in to their secure Provider Portal account or accessing the Portal Home page and selecting the Enrollment Tracking Search link.

Providers will see one of the following status responses:

  • "Approved." ForwardHealth has reviewed the revalidation materials and all requirements have been met. ForwardHealth is completing updates to provider files. Once the updates are complete, the provider's status will be changed to "Revalidated."
  • "Awaiting Additional Info." ForwardHealth has reviewed the revalidation materials and has requested additional information from the provider. The provider will receive a letter in the mail from ForwardHealth specifying the additional information needed.
  • "Denied." The provider's revalidation has been denied. The provider will receive a termination letter from ForwardHealth. To reactivate Medicaid enrollment, the provider will be required to complete a new provider enrollment application and undergo additional screening activities.
  • "In Process." The revalidation materials are in the process of being reviewed by ForwardHealth.
  • "Revalidated." The provider has successfully completed revalidation. There are no actions necessary by the provider.
  • "Referred To DHS." ForwardHealth has referred the provider revalidation materials to the state Enrollment Specialist for a revalidation determination. The provider will be notified by ForwardHealth if there is any additional action required.
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