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DMS program integrity unit to run CMS‑mandated off‑cycle provider revalidation
Summary
DMS said CMS directed an off‑cycle revalidation of provider enrollment over the next 24 months to confirm provider eligibility; prioritized groups include high‑risk and atypical providers and those not revalidated in the prior 12 months.
Jennifer Dudinski, division director for program integrity in DMS, told the TAC that CMS issued a directive in early April requiring an off‑cycle revalidation of provider enrollment data. "CMS gave us a directive in early April ... on completing an off cycle revalidation," she said.
Dudinski outlined the plan: DMS will prioritize providers who have not completed revalidation in the past 12 months; it will start with higher‑risk providers, then atypical providers (those without an NPI), then moderate and limited risk providers. Providers will be notified via the Medicaid Partner Portal Application (MPPA) and by a revalidation letter; DMS said some providers may be asked to complete a dispute form. The stated goal is to ensure the accuracy of provider enrollment data and confirm that only legitimately qualified providers remain active in Medicaid.
Why it matters: Off‑cycle revalidation aims to remove inactive or fraudulent providers from directories and protect program integrity. DMS said it will cross‑reference revalidation results with other network adequacy and billing reports to ensure directories are accurate.
Representative quote: "Providers will be notified, via communications from the Medicaid partner portal application, MPPA. And you will also receive a revalidation letter that outlines the action that you need to take, and by what date you need to do so," Dudinski said.
Ending: DMS offered to share the presentation slides and contact information and invited providers to reach out with questions about the revalidation process.
