To ensure that provider information is accurate and that active providers are still eligible to participate in the Puerto Rico Medicaid Program (PRMP)
Active providers are required to complete revalidation within the specific timeframe established by the Puerto Rico Medicaid Program.
Ensures that the Puerto Rico Medicaid Program (PRMP) complies with federal regulations (42 CFR § 455.414).
Ensures that Puerto Rico beneficiaries continue to receive quality care.
Provides continuity in mitigating the risk of fraud.
When must a provider revalidate?
Any active provider who has received the 90-day revalidation reminder letter must revalidate.
The revalidation notification is obtained in the messages section of the Provider Secure Communication (PSC).
Providers will also receive a Revalidation reminder notification to their “Mail-to” email referring the provider to their PSC account.
The providers will receive the first revalidation reminder 90 days prior to the termination date of their Medicaid agreement.
The Medicaid Program requires all physicians to revalidate their information every 5 years.
Non-physician providers with an effective date before 12/31/2022 must revalidate 4 years from their Medicaid Agreement effective date.
Non-physician providers with an effective date of 1/1/2023 or later must revalidate their information within 3 years from their Medicaid Agreement effective date.
Note: The frequency of revalidation is subject to the terms in section 2.7 of the Provider Agreement.
Communication Plan/Letters
All the Communications sent to the providers related to the Revalidation process will be sent to the email registered as “mail to” and to the Providers Secure Communication.
The letters that providers will be receiving are:
Provider Revalidation Reminder Letter 90 days
Provider Revalidation Reminder Letter 60 days
Provider Revalidation Reminder Letter Final
To view all communication sent to providers regarding Revalidation click here.