VOA MEMBERS: Medicare Revalidation Request Requirements

The Patient Protection and Affordable Care Act requires all (new and existing) Medicare providers (optometrists included) to revalidate their personal information with Medicare. The request by Medicare to revalidate your information is very time sensitive. You will be able to revalidate either by: a) paper application; b) online through the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). You chose.

The following is provided to VOA members as a guide to help you through this process:

Keywords:

NPI: Your National Provider Identifier

PTAN: Your Provider Transaction Access Number with Medicare. You have one for each business entity

you are an OD and billing Medicare with; Your practice has a separate PTAN also. PTAN may have been referred to as your legacy number of Medicare PIN. Think of it as the new generation Medicare ID number.

NPPES: National Plan and Provider Enumeration System. The system that created your NPI. You created a username and password when you set up for your NPI. You use the same Username and Password for your EHR incentive (if you did it). If you don’t remember it, read below for how to easily regain it.

PECOS: Provider Enrollment, Chain, and Ownership System. CMS database that contains provider

information. Requires NPPES username and password to access it. You will be going into the PECOS database to “revalidate” your information.

Key Points:

  • You cannot revalidate your information until you receive your revalidation request letter (yellow envelope) from Palmetto. Some OD members have already received their request
  • You have 60 days from the postmark of the letter to complete the process
    • According to the letter, failure to complete the process within 60 days of the postmark “may result in your Medicare billing privileges being deactivated”
  • Each individual doctor will receive a request
    • You will need the following information to revalidate:
    • All practice location addresses and Tax ID numbers
    • Your National Provider Identifier (NPI)
    • Your Provider Transaction Access Number (PTAN)
      • You have one and your practice has a different one
        • Provider PTAN example: 00X555T36
        • Facility (your office) example: C04785
      • If you practice and bill Medicare under multiple business entities, you will have multiple PTANs.
        • An OD with multiple PTANs from different business entities will submit all their locations and all their business entities with only one revalidation process (it will ask you for all the info)
    • IRS document confirming legal business names
      • Any of the following: CP575; 941; LTR147C
        • Get this info ready before you submit your online revalidation because you only have 15 days from the time of your online revalidation until the IRS documents have to be in Palmetto’s hands.
      • If you practice under different business entities that bill Medicare, you will need IRS documents from each entity (even if you aren’t the owner)
    • If applicable, any Adverse Action Documentation (notifications, resolutions or reinstatement letters)

The letter from Palmetto requesting your revalidation will include your NPI and your PTANs on the letter. If you practice in multiple business entities, the revalidation letter will include all your PTANs on the letter, but it does not indicate which of your offices correlate to which PTAN. You will need to know which correlates to which business entity.

If you have questions, please call Palmetto GBA Provider Contact Center at 1-866-830-3043 or visit www.palmettogba.com/medicare.

  • If you call, the wait time is very short. They may (or may not) ask you for your name, PTAN, NPI and Tax ID number to verify your identity before the talk to you. PTAN and NPI are on your revalidation letter.

Steps to Revalidate

  1. Choose Paper Revalidation or Electronic Revalidation
    1. If you are already a provider in Medicare, the Online Revalidation will already contain most of your information and practice locations.

Online Revalidation

  1. https://pecos.cms.hhs.gov
    1. The system allows you to update the info currently on file, update and submit your revalidation via the internet. If you electronically sign, then you only mail, to the address below, the required supporting IRS documents (and if applicable, bank EFT forms and Adverse Documents forms).
    2. THE REQUIRED MAILED DOCUMENTS MUST BE RECEIVED BY PALMETTO WITHIN 15 DAYS OF YOUR INTERNET SUBMISSION
    3. Username and password for PECOS is the same as you use for NPPES (NPI registration) or EHR incentive registration. It is not your Qualitynet.org/IACS/PQRS report accessing information.
  2. Forgot your NPPES username and password? Call: 1-866-484-8049
    1. If you call, the wait time is usually very minimal
    2. Select option: help with NPPES, PECOS, PECOS Revalidation requests (should be option #3)
    3. You will be asked to verify your identity by providing your NPI, your DOB, your last 4 of your SSN and another security question that you provided in the past (i.e., what state were you born in).
      1. They will provide you with your username
      2. If you ask for it, they will reset your password by giving you a temporary one over the phone.
  3. Going online to Revalidate:
    1. https://pecos.cms.hhs.gov
    2. Login and username
    3. Click My enrollments
    4. Click Revalidate
    5. Click Start application
    6. You will see a list of “topics” including Personal Information, Practice Specialty, PAR status, Physical Location, etc.
      1. View and update each “topic”
    7. After each view and update, then “Return to Fast Track”
    8. Continue updating each “topic”
    9. You can log off and go back as needed and your info should be saved
      1. When you log back in, click “my enrollments”, then “view enrollments”, then “more options”, then “continue working on application”
    10. An “error” meter will monitor if they have flagged any issues for you. Continue through editing your “topics” and then address any errors at the end
      1. Click “error check”
    11. After errors are fixed, click “topic view”
    12. Click “begin submission”
    13. Electronic Signature request occurs here
    14. Click “submit” to finalize the online portion
    15. A reminder will pop up with your documents that need to be printed and sent to Palmetto
    16. PRINT THE RECEIPT. IT INCLUDES YOUR TRACKING ID#. ANY INFO YOU SEND TO PALMETTO WILL REQUIRE THAT TRACKING # (EFT, IRS documents, etc.)
      1. Based on a call by a member OD to Palmetto, the IRS documents are required for all physicians that are revalidating; the banking EFT is only required if you have historically not been getting paid by direct deposit from Palmetto.
    17. Mail required documents with your Tracking ID# as a reference to:

      • Palmetto GBA
        Provider Enrollment
        PO Box 100190
        Columbia, SC 29202-3190

Paper Revalidation

  1. Visit www.palmettogba.com/medicare
  2. Find the box in the middle that says: Self service tools and top links
  3. Click Provider Enrollment/ 855 Form
  4. Click Jurisdiction 11 Part B
  5. Click Enrollment Application Tool
  6. Follow the directions to fill out the application
  7. Print and copy your application (keep a copy)
  8. Mail your original signedand dated application and IRS documents
    1. IRS documents are required and prove your Business Name and Tax ID
    2. Also mail bank EFT if applicable (haven’t been getting paid by direct deposit with Palmetto) and Adverse Action Document if applicable.
  9. Keep the copied version—DO NOT SEND A COPY VERSION TO PALMETTO
  10. Mail to Palmetto address above