What documentation should be submitted with the revalidation?

Answer:
The documentation required by CMS to be submitted with the revalidation depends on the specialty and/or number of locations with active billing privileges a supplier has under an existing tax identification number (TIN). The following chart indicates what documentation must be submitted:

Supplier Type

Required Documentation

IRS

Insurance

Adverse Legal Actions

Application Fee Receipt

> 25 Active Locations 

No - If no change in TIN  

Yes

No

Yes

Yes

< 25 Active Locations

No - If no change in TIN

Yes

Yes

Yes

Yes

If revalidating and supplier is not already enrolled to receive payments through electronic funds transfer, the supplier should submit the Authorization Agreement for Electronic Funds Transfer (CMS 588). Suppliers must ensure the form has the original signature of the authorized or delegated official. Also, suppliers should submit a separate form for each Medicare contractor where it submits claims. In addition, suppliers are required to attach either a voided check, deposit slip or letter on bank letterhead verifying the account information. Either one of these attachments must be included with each form submitted.

Also note, if a supplier is deleting an individual from the supplier file, no additional documentation is required to be submitted. For example, if a supplier is removing a board member, the NSC will not require additional documentation such as board minutes to remove the individual. As long as the appropriate section in PECOS is completed correctly to delete the individual and the certification statement is signed and submitted properly, the individual will be removed from the file.

Contact NSC

Email National Supplier Clearinghouse

Contact a specific NSC department

Telephone: 866-238-9652

IVR: 866-238-9652

Address:

National Supplier Clearinghouse

Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

National Supplier Clearinghouse MAC

Anonymous

 


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