Recredentialing and Revalidation

Originally posted on Late Breaking News 11/3/23

All providers participating in MississippiCAN or the Children’s Health Insurance Program (CHIP) are required to be credentialed by the Mississippi Division of Medicaid. Failure to complete credentialing/recredentialing will result in termination from these programs. There are a significant number of providers currently due for recredentialing that need to complete the process prior to the end of the year. 

During the 2021 Mississippi Legislative Session, Senate Bill 2799 was enacted into law that requires the Medicaid Coordinated Care Organizations (CCO) to follow a uniform credentialing process for provider enrollment in the Managed Care Programs. On July 1, 2022, in accordance with this new requirement, the Mississippi Division of Medicaid (DOM) amended the CCO contracts to require the CCOs to accept DOM’s provider enrollment and screening process, and not require providers be credentialed by CCOs for Medicaid or CHIP.

Beginning October 1, 2022, providers seeking participation in MississippiCAN and/or CHIP are now required to be enrolled, credentialed, and screened by DOM, and subsequently contract with their CCO of choice. As part of the implementation of the Medicaid Enterprise System Assistance (MESA), DOM implemented a new centralized credentialing process along with NCQA certified Centralized Verification Organization (CVO) that will be responsible for credentialing and recredentialing Medicaid providers seeking to enroll or currently enrolled with our coordinated care programs (MSCAN/CHIP). This new process eliminates the need for a provider to be credentialed or recredentialed multiple times.

The CVO will perform recredentialing for both current providers and new providers every three (3) years unless the provider is credentialed by a DOM-approved Delegated Credentialing Entity. Providers identified for recredentialing will receive notification from Gainwell Technologies by letter which is sent to the providers “mail to” address on their provider record. This letter is generated six months in advance of the recredentialing due date on the provider’s record in MESA and a link will be available in the portal to start the process.

Facilities with multiple service locations and provider IDs will receive a recredentialing notice for each provider ID. Only one provider ID for the same tax ID and service location address will need to submit the recredentialing application which will pick up and credential all the taxonomies at that location. If recredentialing is either denied or not completed by the recredential due date, all the facility enrollments at that location will be terminated and claims can no longer be paid. A new application for each taxonomy at that service location will be required to re-enroll in the Mississippi Medicaid program.

Individual providers with multiple provider IDs sharing the same NPI will receive a recredentialing notice for each of the provider IDs. The provider will only need to recredential one of the IDs to satisfy the requirement for all. If recredentialing is either denied or not completed by the recredential due date, all the individual provider’s enrollments will be terminated, and claims can no longer be paid. A new application for each service location will be required to re-enroll in the Mississippi Medicaid program.

To prepare for recredentialing, all Medicaid providers should take the following steps immediately:

• Each enrolled provider must register for access to the MESA Provider Portal to recredential electronically. This will streamline the process and allow providers to enter their own information. Providers can register now by going to https://portal.ms-medicaid-mesa.com/and clicking the “Register Now” link.
• In addition to the notices mailed by Gainwell Technologies, providers can refer to DOM’s website where we are posting the Provider Six Month Recredentialing Due List” at https://medicaid.ms.gov/. This listing will be updated monthly.
• Review the Provider Recredentialing Presentation found at https://medicaid.ms.gov/wp-content/uploads/2023/10/Provider-Recredentialing-v.1.pdf, which is a PDF that includes a recredentialing walk through and tips for providers.
• Providers should verify that the address information on file is correct. The notifications will be mailed to the “Mail To” address on their file. To ensure each individual provider receives a notification, please validate your addresses on file, and correct them if necessary.
• If changes are needed, complete the Provider Change of Address form, located under Provider Forms at https://medicaid.ms.gov/resources/forms/.
• The Provider Change of Address form must be completed, signed by the individual provider or authorized official if enrolled provider is a business, and submitted to the Provider Enrollment Department of Gainwell Technologies via secure correspondence in the MESA Provider Portal, fax, or mail. The following correspondence information is provided:

o Provider Services Fax Number:
(866) 644-6148
Attention: Provider Enrollment

o Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.

Originally posted on Late Breaking News 10/31/23

Effective May 11, 2023, the Health and Human Services Commission (HHSC) ended the flexibility of extended Medicaid provider revalidation dates that came due during the COVID-19 public health emergency (PHE). With the ending of the Public Health Emergency, the Mississippi Division of Medicaid resumed the revalidation process effective Oct. 1, 2023, requiring Mississippi Medicaid enrolled providers to verify the information on their provider files. Medicaid provider revalidation is a requirement stemming from 42 C.F.R. § 455.414 of the Affordable Care Act (ACA), which requires all state Medicaid agencies to revalidate the enrollment of all providers at least every five years.

A revalidation requires a provider to verify or revalidate the information currently on the enrolled provider’s file. Providers also will need to complete and sign a new Provider Disclosure form and a new Provider Agreement. As part of the revalidation, the state must conduct a full screening appropriate to the provider’s risk level in compliance with 42 C.F.R. Part 455, Subparts B & E, and the provider must comply with any requests made by the state as part of the revalidation process within the specified time frame.

Beginning in October 2023, notification letters were mailed to providers who have been enrolled with Medicaid for five years or more. Revalidation notices will be issued on a staggered schedule until notices have been issued to all providers due for revalidation. The revalidation notice will initiate the process with each provider. The letter will provide instructions for completing the revalidation and will indicate the due date. Revalidating providers may need to submit additional documentation and/or complete other required screening requirements (i.e., provide fingerprints and/or a site visit of the provider location conducted by Medicaid’s fiscal agent).

Certain revalidating providers must pay a provider enrollment application fee. Refer to https://medicaid.ms.gov/provider-enrollment-application-fee/ for a list of institutional providers that have to pay the application fee. Providers who have already paid the application fee to Medicare or another state’s CHIP or Medicaid program for same provider have fulfilled the requirement and should choose the appropriate drop-down option when completing the revalidation application.

Providers will be able to revalidate through the MESA Provider Portal in a simple, step-by-step process. Providers should submit their revalidation by the submission date on their letter to allow time for processing before the deadline date. Providers whose revalidation is not processed before the deadline noted on the letter will be terminated and this termination will include participation in MississippiCAN and/or MississippiCHIP and the provider will therefore have to reapply.

Resumption of revalidation operations will eventually affect all providers, but DOM will begin with those providers who have been enrolled five years or more. Meanwhile, revalidation dates will be set for newer providers who have not yet been enrolled five years. To prepare for revalidation, all Medicaid providers should take the following steps immediately:

• Each enrolled provider must register for access to the MESA Provider Portal to revalidate electronically. This will streamline the process and allow providers to enter their own information. Providers can register now by going to https://portal.ms-medicaid-mesa.com/and clicking the “Register Now” link.
• In addition to the notices mailed by Gainwell Technologies, providers can refer to DOM’s website where we are posting the Provider Six Month Revalidation Due List” at https://medicaid.ms.gov/. This listing will be updated monthly.
• Review the Provider Revalidation Presentation found at https://medicaid.ms.gov/wp-content/uploads/2023/10/Provider-Revalidation-Process-v.1.pdf, which is a PowerPoint that includes a revalidation walk through and tips for providers.
• Providers should verify that the address information on file is correct. The notifications will be mailed to the “Mail To” address on their file. To ensure each individual provider receives a notification, please validate your addresses on file, and correct them if necessary.
• If changes are needed, complete the Provider Change of Address form, located under Provider Forms at https://medicaid.ms.gov/resources/forms/.
• The Provider Change of Address form must be completed, signed by the individual provider or authorized official if enrolled provider is a business, and submitted to the Provider Enrollment Department of Gainwell Technologies via secure correspondence in the MESA Provider Portal, fax, or mail. The following correspondence information is provided:

o Provider Services Fax Number:
(866) 644-6148
Attention: Provider Enrollment

o Provider Services Mailing Address:
Provider Enrollment/MississippiCAN/MSCHIP
PO Box 23078
Jackson, MS 39225

Should you need assistance, please contact the Provider and Beneficiary Services Call Center at (800) 884-3222 or use the Provider Field Representative list on Medicaid’s website to identify your designated representative. The Provider Field Representative list includes email addresses and phone numbers for each representative. This resource document is located https://medicaid.ms.gov/wp-content/uploads/2022/12/Provider-Field-Representatives.pdf.