- (1) An enrolled provider must revalidate with Medicaid through PRISM at intervals not to exceed five years as required by 42 CFR 424.515, depending on the provider's risk level.
- (2) The Department shall notify a provider, when it is time to revalidate, with a letter mailed to the pay-to address in the PRISM system.
- (3) A provider must complete and submit the revalidation process within 60 days from the date of the letter, or the Department will place a temporary payment hold on the provider account.
- (4) The Department shall terminate a provider that fails to revalidate within 90 days from the date on the letter. The provider, however, has the option to request a fair hearing.
- (5) A provider terminated for any reason must reenroll and be approved as a new provider.
- (6) The Department may only reimburse a provider for services rendered during an enrollment period.
KEY: Medicaid
Date of Last Change: November 10, 2023
Notice of Continuation: September 16, 2024
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108