A provider who was enrolled and credentialed correctly can still stop getting paid if a revalidation or recredentialing deadline is missed. Medicare, Medicaid and commercial plans each re-check providers on their own schedule, and the reminders are easy to lose. This guide explains each cycle, what happens if you miss one, and how to plan 2027 so no provider in your practice falls out of network.
The Three Renewal Cycles
| Who | How often | Where it is done |
|---|---|---|
| Medicare revalidation | Every 5 years for most providers and groups; every 3 years for DMEPOS suppliers (42 CFR 424.515) | PECOS, the Medicare enrollment system, or a paper application |
| Medicaid revalidation | At least every 5 years (42 CFR 455.414) | Your state Medicaid agency’s enrollment portal |
| Commercial recredentialing | Usually every 3 years, the cycle most plans follow under accreditation standards such as NCQA’s | Each plan, usually using your CAQH ProView profile |
How Medicare Revalidation Works
- CMS publishes revalidation due dates in its Medicare Revalidation List, searchable by name or NPI. Due dates are set about 7 months ahead.
- Your Medicare Administrative Contractor (MAC) sends a notice, usually by email or letter, a few months before the due date. Do not wait for it; it can go to an old address.
- Groups and their individual providers each have their own due dates. Check every provider, not just the group.
- Submit the revalidation in PECOS, together with any reassignment of benefits to your group, and keep the confirmation.
What Happens If a Deadline Is Missed
Medicare
- Billing privileges can be deactivated (42 CFR 424.540)
- Claims for that period may not be paid
- Reactivation needs a new, complete application
Commercial plans
- The provider can be removed from the network
- Claims then pay out of network, or not at all
- Rejoining can mean full credentialing again
Keep CAQH ProView Current All Year
Commercial recredentialing depends on the same CAQH ProView profile used for initial credentialing. If the 120-day attestation lapses or a license or malpractice certificate expires in the profile, a plan’s recredentialing can stall and the provider can be dropped. Our CAQH ProView guide explains how to keep it current.
Build a 2027 Calendar
- List every provider and the group, with their NPIs.
- Look up each Medicare revalidation due date in the CMS list, and each state Medicaid due date.
- Add each commercial plan’s recredentialing date, usually 3 years from the last approval.
- Add license, DEA and board certification expiration dates, and the CAQH attestation date for each provider.
- Set a reminder 90 days before each date, and give one person ownership.
What to Ask a Credentialing Company
- Do you track revalidation and recredentialing dates for every provider, or only new enrollments?
- Will you warn us at least 90 days before each due date?
- Do you manage CAQH attestations and document uploads between credentialing cycles?
- Will you send us confirmation of each submission and approval?
Compare credentialing companies on PracticeVendors, or read how long credentialing takes when a new provider joins.
