Prevent Revalidation Processing Delays

When National Government Services receives a revalidation application, we often determine additional information is needed to process the application. In those cases, a request for additional information is sent which is commonly referred to as development. Sending development requests and waiting for responses delay processing times.

One way to prevent a common delay is by ensuring you meet the name matching requirements before submitting an application:

For Who	Requirements
For Individuals and Individual Sole Proprietors enrolled under a SSN or an EIN, the legal name reported on enrollment applications, EFT agreements and all of these sources must match exactly Note: If you have employees, an EIN is required	The individual’s legal name reflected in Social Security records The individual’s legal name reflected in the NPPES Registry for the Type 1 NPI The individual’s legal name reflected on a voided check or bank confirmation letter when applicable The individual’s legal name reflected in the IRS records as demonstrated by an IRS-CP575, IRS-147C or other approved form (if enrolled under an EIN) and this must match the individual’s legal name in Social Security records
For Individuals Who are Sole Owners of an Organization, the individual’s legal name and Legal Business Name reported on enrollment applications, EFT agreements and all of these sources must match exactly	The individual’s legal name reflected in Social Security records The individual’s legal name reflected in the NPPES Registry for the Type 1 NPI The organization’s legal business name reflected in the NPPES Registry for the Type 2 NPI The organization’s legal business name on a voided check or bank confirmation letter The organization’s legal business name reflected in the IRS records as demonstrated by an IRS-CP575, IRS-147C or other approved form The organization’s legal business name on applicable state corporation websites
For Organizations, the legal business name reported on enrollment applications, EFT agreements and all of these sources must match exactly	The organization’s legal business name reflected in the NPPES Registry for the Type 2 NPI The organization’s legal business name on a voided check or bank confirmation letter The organization’s legal business name reflected in the IRS records as demonstrated by an IRS-CP575, IRS-147C or other approved form The organization’s legal business name on applicable state corporation websites

The table below contains the top reasons for development and how to prevent them. Using PECOS to submit your revalidation application can also help prevent development requests since you are verifying information already on file rather than fully completing a blank paper application.

Common Missing or Incomplete Items	How to Prevent When Submitting a Paper Application	How to Prevent When Submitting a PECOS Application
EFT Information	Fully complete and send the form CMS-588 EFT Authorization Agreement. Be sure to: Specify the legal name on the EFT agreement and that name must match exactly (including middle initial, suffix, credentials) the name on file with the IRS or SSA and on the voided check or bank letter. Check either SSN or EIN box. Check either checking account or savings account box. Include a voided check. If the voided check is not an exact name match to what is reported to the IRS or SSA, it is recommended that you obtain and include a bank letter specifying your name to match.	If EFT information is already present, verify the information is accurate. If EFT information is missing or requires updates, enter the information into the EFT topic. Ensure the legal name on the EFT agreement matches exactly (including middle initial, suffix, credentials) the name on file with the IRS or SSA and on the voided check. Upload (PDF or TIFF) a copy of the voided check. If the voided check is not an exact match to what is reported to the IRS or SSA, it is recommended that you obtain and upload (PDF or TIFF) a bank letter specifying your name to match.
NPPES Registry Name Mismatches	Check the NPPES Registry to verify your NPI and name. An individual’s name and an organization’s legal business name on file with NPPES must match what is reported to Medicare and the IRS or SSA records exactly. If an NPPES correction is necessary, complete the correction prior to submitting your revalidation application.	Check the NPPES Registry to verify your NPI and name. An individual’s name and an organization’s legal business name on file with NPPES must match what is reported to Medicare and the IRS or SSA records exactly. If an NPPES correction is necessary, complete the correction prior to submitting your revalidation application.
Not Addressing All PTANs and/or Affiliations Identified in the Revalidation Request Letter	Ensure that the form CMS-855I or CMS-855B addresses each current and/or terminated PTAN and/or affiliations: CMS-855I specify current information in section (as applicable): 4B- Sole Proprietor/Sole Owner practice locations 4F- Individual/Organization/Group Receiving the Reassigned Benefits CMS-855B specify current information in section: 4A-Entity practice locations	Ensure the revalidation application addresses each current or terminated PTAN’s and/or affiliations.
Missing Nonphysician Practitioner Certification Documents	Include a copy of required certification(s) for a nonphysician practitioner.	Upload a copy of required certification(s) for a nonphysician practitioner.
Missing or Expired State Required Registrations	Ensure all state required registrations are current. Complete necessary updates prior to submitting your revalidation application. Each state has unique requirements, processes and websites that may vary for individuals and businesses. Each provider will need to follow their individual state’s requirements. The J6 State Licensing and Certification websites and the JK State Licensing and Certification websites page contains helpful links to websites of some organizations within the J6 and JK states that can be used to verify your licensing or certification status. *Note for New York Providers:* Physicians, nonphysician practitioners and professional practice corporate entities in the state of New York are required to maintain registration with the New York State Education Department (NYSED) Office of Professions; access this website to ensure your registration is current.	Ensure all state required registrations are current. Complete necessary updates prior to submitting your revalidation application. Each state has unique requirements, processes and websites that may vary for individuals and businesses. Each provider will need to follow their individual state’s requirements. The J6 State Licensing and Certification websites and the JK State Licensing and Certification websites page contains helpful links to websites of some organizations within the J6 and JK states that can be used to verify your licensing or certification status. *Note for New York Providers:* Physicians, nonphysician practitioners and professional practice corporate entities in the state of New York are required to maintain registration with the New York State Education Department (NYSED) Office of Professions; access this website to ensure your registration is current.
Incorrect Provider Social Security Number or Date of Birth	Specify the correct Social Security Number and date of birth in Section 2A of the form CMS-855I.	Verify
Missing Practice Location Information in Section 4 of the CMS-855I and CMS-855B	Specify all practice locations in Section 4 of the form CMS-855I or the form CMS-855B. When adding a new practice location, specify the date you saw your first Medicare patient at that location.	Verify. If adding a new practice location, specify the date you saw your first Medicare patient at that location.
Missing Answers to Final Adverse Legal Actions/Convictions Questions	Questions regarding final adverse legal actions/convictions appear in multiple sections of both forms CMS-855I and CMS-855B. Ensure that you select the applicable box ‘Yes’ or ‘No’ for each section you complete. CMS-855I - Sections 3, 4A and 6B (there must be a corresponding Section 6B for each Section 6A) CMS-855B – Sections 3, 5B and 6B (there must be a corresponding Section 5B for each Section 5A and a corresponding Section 6B for each Section 6A) If answering ‘Yes,’ include a copy of the final adverse legal action documentation and resolution.	Verify
Missing signatures for New Authorized Official (AO) or Delegated Official (DO) when Adding New AO or DO	The form CMS-855B Section 15 must be signed by one authorized or delegated official to revalidate. If adding a new AO, then the new AO must complete Section 6A and 6B and sign Section 15B. If adding a new DO, then the new DO must complete Section 6A and 6B and sign Section 15D as well as an AO signature in Section 15B and 15D.	Obtain signature(s)
Missing Information for Individuals Having Managing Control in Section 6 of the CMS-855I	Copy and complete Section 6 of the form CMS-855I for all managing employees. For each person listed in Section 6A, there must be a corresponding Section 6B.	Verify
Missing Information for Individuals with Ownership Interest and/or Managing Control in Section 6 of the CMS-855B	Copy and complete Section 6 of the CMS-855B for all individuals who have ownership interest and/or managing control. For each person listed in Section 6A, there must be a corresponding Section 6B.	Verify