Revalidation

Provider revalidation is a required recurring process where healthcare providers confirm, update and re-verify their enrollment information, credentials and practice details with the Healthy Connections Medicaid program to maintain active billing privileges and continue receiving payments for submitted claims.

SCDHHS will notify providers when to begin the revalidation process and the specific date by which the provider's enrollment must be revalidated. Providers are divided into groups for the provider enrollment revalidation. Providers should not take any steps to revalidate their enrollment until they receive an official notification letter from SCDHHS.

Revalidation Application

WHAT'S NEW 

Under federal regulation 42 CFR § 455.414, state Medicaid agencies are required to revalidate the enrollment of all participating healthcare providers at least every five years. Revalidation is a mandatory process that periodically reviews a provider’s credentials, ownership and practice information to ensure continued eligibility. Periodically, SCDHHS updates the provider revalidation process. 

South Carolina Provider Revalidation Strategy, June 2026

In April 2026, CMS launched a sweeping federal initiative aimed at eliminating fraud, waste and abuse amongst Medicaid health providers. State Medicaid agencies were directed to perform a rapid revalidation of high-risk Medicaid providers and to submit a comprehensive two-year provider revalidation strategy. South Carolina’s CMS-approved plan includes a complete revalidation of providers who had an initial enrollment prior to June 1, 2025. To further support the Centers for Medicare & Medicaid Services (CMS) efforts to prevent fraud, waste and abuse, South Carolina Healthy Connections Medicaid has adopted more frequent revalidation intervals than the federal minimum.

• South Carolina Provider Revalidation Strategy, June 2026

Key Changes Effective June 1, 2026

• Providers classified as high-risk under 42 C.F.R. § 455.450, as well as those South Carolina Medicaid provider types designated as high-risk by state policy, must complete revalidation annually.
• All other providers will be required to revalidate every three years.

These enhanced intervals help maintain program integrity and ensure provider information remains accurate and up to date.

2026 Provider Revalidation Cohorts:

Rapid Revalidation Cohort: Opioid Treatment Programs, Durable Medical Equipment, Home Health Agencies, Hospice, Skilled Nursing Facilities, Private Rehabilitative Behavioral Health Service, Individual Licensed Psychologists, Licensed Independent Social Workers – Clinical Practice, Licensed Professional Counselors, Licensed Marriage and Family Therapists, Licensed Psych-Educational Specialists, Board Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and the multi-specialty groups comprised of the licensed independent practitioners identified above.  Additionally, providers enrolled through Community Long-Term Care offering home and community-based services will revalidate with this cohort. 

Restart of Provider Revalidation, June 2024

Flexibilities offered by the Centers for Medicare and Medicaid Services (CMS) to all state Medicaid agencies during the federal COVID-19 public health emergency (PHE), allowed for the temporary suspension of the Medicaid provider enrollment revalidation process. With the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) was required to resume the provider revalidation process in June 2024.

• Medicaid Bulletin (MB# 24-022), Restart of Provider Revalidation

Resources

• SCDHHS shares information about updates to provider revalidation and other processes through the Medicaid Advisory Council (MAC). For information about upcoming meetings, as well as previous presentations, please visit the Committees and Groups page of our website.
• For more information about provider revalidation, providers may call the PSC at (888) 289-0709, option 4, reference the issue code REVAL.
• Sample Provider Enrollment Revalidation Letter 
• Sample High-risk Provider Letter

FAQs

Are all providers required to go through the revalidation process?
Yes. CMS requires all providers to revalidate based on their designated risk level. Federal guidelines require limited and moderate risk providers to complete revalidation every five years, and high-risk providers revalidate every three years. South Carolina has adopted more frequent revalidation intervals than the federal minimum.

What do I need to do to prepare for revalidation?
It is highly recommended you make sure your national provider identifier (NPI), Medicaid provider ID, tax ID, mailing address, service location address and name are current with SCDHHS. Refer to your respective provider manual for instructions on how to complete the update process.

How do I make sure my address and other information is correct?
To verify your current address, you may check the provider directory here. To confirm other information, contact PSC at (888) 289-0709, select option 4 and reference the issue code REVAL. The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.

The PSC representative cannot change your address if you identify a discrepancy. You must submit a signed letter requesting the address change on business letterhead with an authorized printed name and signature.

How will I be notified?
South Carolina Healthy Connections Medicaid will notify providers via a letter. This letter will include a unique revalidation number. You will use this information to access the online provider revalidation enrollment application and also to follow-up on the status of your revalidation through the PSC at (888) 289-0709, option 4 and reference the issue code REVAL. The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.

Where should I expect my revalidation notification letter to be mailed?
Your revalidation notification letter will be mailed to the primary practice location SCDHHS has on file. Contact the PSC at (888) 289-0709, select option 4, reference the issue code REVAL and ask for confirmation of the primary practice location and payment address associated with each of your Medicaid legacy numbers. The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.

The PSC representative cannot change your address if you identify a discrepancy. You must submit a signed letter requesting the address change on business letterhead with an authorized printed name and signature.

Will all providers revalidate at the same time?
No. You will receive a letter from SCDHHS when it is your turn to revalidate. Please do not attempt to begin the revalidation process until you have received direct instruction from SCDHHS.

When is revalidation due?
Providers have 30 days from the date of their notification to complete and submit their application.

What if I do not submit my provider revalidation by the deadline?
Providers who do not complete and submit the provider revalidation application within the timeframe will be considered voluntarily terminated from the Healthy Connections Medicaid program. Providers will no longer receive payments and will need to reapply as a Healthy Connections Medicaid provider.

I have not received my revalidation notification letter, is there another way that I can get my revalidation number?
Contact the PSC at (888) 289-0709, option 4, reference the issue code REVAL and request a duplicate revalidation notification letter. The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.

The PSC cannot provide your unique revalidation number via phone.

Approximately how long does it take to complete and submit a provider revalidation application?
The amount of time to complete and submit the online portion of a provider revalidation application should take approximately 30 minutes. Being prepared with all required application information (i.e., NPI, tax and ownership information) will help expedite the completion and submission of the application. Providers who are designated as high-risk have additional requirements. These include fingerprint submission and/or a physical site visit. This part of the process may take longer than the 30-day deadline. If you are a high-risk provider, as long as you submit a copy of your fingerprinting appointment confirmation along with other requested documents, you will not be terminated.

Can an organization request revalidation information for their providers?
If an organization determines their providers are up for revalidation in the current provider group, they may request revalidation information for each provider by submitting a contact a provider representative inquiry or calling the Provider Service Center (PSC) at (888) 289-0709, option 4 and reference the issue code REVAL The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.

What if I change my Electronic Funds Transfer (EFT) Authorization Agreement during revalidation?
Please be advised any change to your financial information is subject to a 15-day prenotification period in which all accounts are verified by the qualifying financial institution before direct deposits are made to your account. During the prenotification period, the provider will receive reimbursement via a hard copy check. The hard copy check will be mailed to the payment address currently on file. Refer to the EFT section of the Provider Administrative and Billing Manual for additional EFT information or contact the PSC at (888) 289-0709 and selection option 4.

What if I have additional questions?
If you have additional questions regarding provider revalidation, please contact the PSC at (888) 289-0709, select option 4, and reference the issue code REVAL. The PSC is open Monday through Thursday from 7:30 a.m. to 5 p.m. and Friday from 8:30 a.m. to 5 p.m.