SCDHHS Resumes Provider Revalidation Process for Medicare and Medicaid

Flexibilities offered by the Centers for Medicare and Medicaid Services (CMS) to all state Medicaid agencies during the federal COVID-19 public health emergency (PHE), allowed for the temporary suspension of the Medicaid provider enrollment revalidation process. With the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.

In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider's demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.

Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as "high-risk" providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please visit here on SCDHHS' website.

Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification.

Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.

The provider types who make up cohorts one and two are listed below. A list of providers scheduled for revalidation will be published on the SCDHHS website at www.scdhhs.gov/providers/revalidation as each cohort's revalidation period begins.

SCDHHS is revalidating all Medicare and Medicaid providers starting June 2024.Photo bySCDHHS

SCDHHS will be revalidating providers starting in June 2024Photo bySCDHHS