Medi-Cal Revalidation Application Packet
Medi-Cal Revalidation
Revalidation is the process in which a provider must resubmit and recertify the accuracy of its Medicaid (Medi-Cal) enrollment information. Providers are required to revalidate (or renew) their enrollment record periodically to maintain Medicare and/or Medi-Cal billing privileges.
The California Department of Public Health (CPDH), in conjunction with the Department of Health Care Services (DHCS), is responsible for the oversight of revalidation for providers enrolled in the Medi-Cal program to ensure the provider meets applicable enrollment criteria.
Provider Screening and Enrollment
Provider Screening and Enrollment requirements are set forth in Title 42, Code of Federal Regulation (CFR) 455, Subpart E. Requirements may include (but not limited to) collecting an enrollment application, conducting background checks, conducting database checks, conducting on-site visits, and collecting an application fee. States reserve the right to establish screening methods in addition to and more stringent than those required by federal regulations as outlined in 42 CFR 455.452.
Pursuant to Title 42, CFR 455.414 Revalidation of Enrollment
“The State Medicaid agency must revalidate the enrollment of all providers regardless of provider type at least every 5 years."
The Centers for Medicare and Medicaid Services (CMS) also reserves the right to request off-cycle revalidations.
Revalidation Process For Continued Enrollment:
CDPH sends a written notice to the provider when it is time for the provider to revalidate enrollment in the Medi-Cal program
Providers must respond within 35 days of the date of the written notice indicating whether they will elect to continue enrollment or voluntarily withdraw
Failure to respond within 35 days results in automatic termination and deactivation from the Medi-Cal program
For providers that elect to continue enrollment, CDPH will provide application instructions
Providers are required to submit a complete revalidation application within 70 days of receiving instructions
For providers that elect to voluntarily withdraw from enrollment, proceed by following the voluntary withdraw instructions
Providers are required to submit a written notice indicating they will elect to voluntarily withdraw from Medi-Cal certification within 70 days of receiving instructions
Failure to submit a complete application or written notice of voluntary withdraw within the 70 day timeframe results in automatic termination and deactivation
CDPH will review and process the revalidation applications and notify providers of identified deficiencies
Providers have 60 days to correct identified deficiencies
Failure to respond to revalidation requests, submit required revalidation materials, or meet program eligibility requirements will result in provider deactivation or disenrollment in accordance with State and federal requirements
For providers who pass the revalidation application review process, applications are forwarded to the local district office to conduct an on-site visit
How to Apply
An applicant must submit a completed application packet to the License Renewal and Certification Branch (LRCB). The provider checklist identifies the required forms and supporting documents needed to apply for revalidation.
Please refer to the following link to get started:
Application Packet Forms
Where to Submit Applications
Submit completed application packets to LRCB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Licensing and Certification Division
License Renewal and Certification Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377
Revalidation Application Questions
Email: Medi-CalRevalidations@cdph.ca.gov