Provider Type Information for Revalidation

Revalidation Information by Provider Type

The federal regulation at 42 CFR § 455.414 requires that state Medicaid agencies revalidate the enrollment of all providers, regardless of provider types, at least every 5 years.

When revalidating businesses (EIN enrollment) that have more than one service location, a separate revalidation for each different location is required.

If a fee is required, it is applicable to each service location. Please review the Provider Type information below to determine if the fee is required.

Individuals (SSN enrollment) complete only one revalidation regardless of the number of affiliated groups. (If an individual MD, nurse, PA, PT, etc., is revalidated by an authorized agent, only one revalidation can be completed.)

Waiver service providers select the Home and Community-Based Services (HCBS) provider type for revalidation requirements.

Before beginning a revalidation through the Provider Portal, please take a minute to review the:

After reviewing the training materials, log into the Provider Web Portal to begin revalidation. 

Terms and Definitions

RISK LEVEL

Each provider type is designated low, moderate, or high risk.

FEE REQ’D?

The provider type is required to pay a fee as required by Federal regulation.

NPI REQ’D?

The provider is required to have a National Provider Identifier (NPI).

MEDICARE REQ’D?

The provider type is required to be an approved Medicare provider.

OOS ALLOWED?

(Out-of-state (OOS) enrollment allowed?) The provider type allows for out-of-state service locations.

BT ALLOWED?

(Border town (BT) enrollment allowed?) the provider type allows the service location to be in an approved border town. Please see Appendix F for a list of approved border towns.

Provider Types

Click on the provider types below for more revalidation details.