Off Cycle Revalidations

Kentucky Medicaid has been directed by the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), to complete off-cycle revalidations over the next 24 months.  The goal of this off-cycle revalidation is to ensure the accuracy of provider enrollment data and confirm that only legitimate, qualified providers are enrolled and participating.

During this off-cycle revalidation, KY Medicaid will focus on providers that have not revalidated in the last 12 months. KY DMS will prioritize the review of identified providers in the following order:

• High Risk
• Atypical  (Providers with no NPI)
• First Moderate risk
• Then Limited risk
• Moderate Risk
• Limited Risk

Providers identified in any of these categories will be notified of their off-cycle revalidation requirement via notification from the Medicaid Partner Portal Application (MPPA) and will receive a revalidation letter outlining the action they need to take. These providers will need to submit a revalidation in MPPA, even if they revalidated in the last four years.

KY Medicaid has 24 months to complete this off-cycle revalidation. Due to this deadline, it is imperative that providers complete their revalidation and submit it as soon as they receive their notification/ letter.  This will allow DMS to review and process these revalidations in a timely manner, prevent provider billing issues, and meet the required deadline. Any updates that need to be made to a provider file can be included in the revalidation instead of submitting a separate maintenance. 

DMS thanks you for your cooperation and assistance in this matter.