Provider Revalidation Information
The Affordable Care Act mandates that states revalidate the enrollment of all providers at least every five years. Beginning in April 2014 and monthly thereafter, DCH and DXC sent letters to providers requiring they revalidate their enrollment within 60 days of the date on the letter.
Effective November 1, 2019, DCH will suspend those providers who were previously sent revalidation notices but have failed to submit a revalidation application. As noted in the revalidation letter, DCH allowed providers a period of 60 days to revalidate. Those providers who failed to revalidate their enrollment within the 60-day time frame will be suspended from the Georgia Medicaid/PeachCare for Kids program effective November 1, 2019. A suspension letter will be mailed to all impacted providers via certified mail. It is critical that providers ensure that their mail-to-address is correct in the Georgia Medicaid Management Information System (GAMMIS). Providers can review or update their mail-to address information by logging into GAMMIS and clicking on the Demographic Maintenance page.
The suspension will apply to providers enrolled in Traditional Fee-for-Service Medicaid and PeachCare for Kids and the Georgia Families and Georgia Families 360° managed care programs which are currently administered by WellCare, Peach State Health Plan, CareSource and Amerigroup. Claims for services to members enrolled in Traditional Fee-for-Service Medicaid and PeachCare for Kids and the Georgia Families and Georgia Families 360° managed care programs for dates of service on or after November 1, 2019 will not be paid.
Upon successfully revalidating, your suspension will be lifted. However, your effective date will be the date that you revalidated. Retro–enrollment is not applicable in this instance. Should you fail to revalidate your enrollment within thirty days of receipt of the suspension letter, you will receive a notice of termination from DCH. The notice of termination will outline your appeal rights.
A report of those providers who have not submitted a revalidation application can be found online on the GAMMIS website at www.mmis.georgia.gov. Click on Provider Information/Reports for Public Access at here. From there, go to the drop down menu at the bottom of the page and select "Revalidation Past Due." Providers who are on this report who have not submitted a revalidation application by November 1, 2019 will be suspended.
The Frequently Asked Questions (FAQ) regarding revalidation can be found on GAMMIS at www.mmis.georgia.gov. Click on Provider Information/FAQ for Providers. In addition, providers may contact Medicaid’s fiscal agent DXC at 800-766-4456 (Option #1).