Payer Enrollment Platform

Every state runs its own clock. You need one board.

A group operating in six states is not managing one enrollment. It is managing six portals, six revalidation cycles, and one federal ownership-disclosure standard that every one of them enforces differently.

The short answer: Medicare revalidates enrollment at least every five years under 42 CFR 424.515, and state Medicaid programs revalidate at least every five years under 42 CFR 455.414. The clocks do not align, the portals do not talk, and a single missed revalidation deactivates billing in that state. Credential OS puts all of them on one geo-grid so nothing lapses silently.

5 yr
Maximum Medicaid revalidation interval per provider
42 CFR 455.414
5% +
Ownership interest that triggers mandatory disclosure
42 CFR 455.104
3 tiers
Limited, moderate, high screening levels by provider type
42 CFR 455.450
1 system
PECOS feeds Medicare; every state runs its own portal
CMS PECOS

The Map / State Portal Grid

One provider, one national footprint, ten different front doors

Federal enrollment lives in PECOS. Medicaid enrollment lives in each state's own portal, on each state's own revalidation calendar. Here is what a multi-state group is actually tracking. Cycle length reflects the federal five-year ceiling under 42 CFR 455.414; the meter shows illustrative time-elapsed against that ceiling, not a real client schedule.

CA
PAVE / DHCS
5yr cycle
re-enroll window near
TX
TMHP
5yr cycle
mid-cycle
NY
eMedNY
5yr cycle
tracking
PA
PROMISe
5yr cycle
action soon
FL
FMMIS
5yr cycle
early
OH
PNM
5yr cycle
mid-cycle
GA
GAMMIS
5yr cycle
tracking
IL
IMPACT
5yr cycle
action soon
NC
NCTracks
5yr cycle
mid-cycle
WA
ProviderOne
5yr cycle
tracking
MI
CHAMPS
5yr cycle
mid-cycle
DME
PECOS / 424.57
3yr cycle
shorter clock
early in cycle approaching revalidation action window open DMEPOS suppliers revalidate every 3 years, not 5, per 42 CFR 424.57

The Revalidation Clock

Why a five-year cycle still needs a monthly watch

Revalidation is not a single date. Each state sends notices on its own lead time, holds its own document window, and deactivates on its own deadline. Miss the window and re-enrollment, not renewal, is what you file next.

Lead times shown are the shape of the process, not a fixed federal schedule. States set their own notice windows, which is exactly why a group cannot track this from a spreadsheet of due dates alone. The window, not the date, is what you manage.

42 CFR Part 455, Subpart B

The disclosure standard is federal. The enforcement is per state.

Ownership and control disclosure is the requirement most likely to stall a multi-state group, because it changes every time the group's cap table changes and it must be current in every state at once.

42 CFR 455.104

Ownership and control interest

Disclose every person or entity with a 5% or greater ownership or controlling interest, plus managing employees and agents.

  • Names, addresses, dates of birth, and SSN or EIN
  • Relationships among owners of the disclosing entity
  • Refreshed at enrollment, revalidation, and on request
42 CFR 455.105 & 455.106

Transactions and convictions

Disclose business transactions with subcontractors on request, and any managing employee or owner convicted of a program-related crime.

  • Subcontractor transactions within the prior 12 months
  • Criminal conviction history for owners and agents
  • A conviction can bar or terminate enrollment
42 CFR 455.450 & 455.436

Screening and database checks

Providers screen at limited, moderate, or high risk by type. States verify against federal exclusion and licensure databases at each cycle.

  • Risk tier drives fingerprinting and site-visit rules
  • Checks against the OIG LEIE and SAM exclusion lists
  • 21st Century Cures Act 5005 requires ordering and referring provider enrollment

Federal vs State, Side by Side

What PECOS covers, and what it does not

PECOS is the system of record for Medicare, and it feeds ordering and referring status nationally. It is not your Medicaid enrollment. This is the gap a payer enrollment platform has to close.

DimensionPECOS (Medicare)State Medicaid Portal
AuthorityCMS, 42 CFR 424 Subpart PState agency, 42 CFR 455 Subpart E
Enrollment formCMS-855A/B/I/RState application (PAVE, TMHP, NCTracks, and others)
Revalidation intervalAt least every 5 years (424.515); DMEPOS every 3 (424.57)At least every 5 years (455.414), state may be shorter
Ownership disclosure855 disclosure sections42 CFR 455.104 to 455.106, per state form
Application feeIndexed annual fee (424.514)Indexed annual fee (455.460), often accepted from Medicare
Deactivation riskLoss of Medicare billing privilegesLoss of billing in that one state only

Why this matters operationally: a group can be perfectly current in PECOS and still lose Medicaid billing in three states because nobody was watching those three portals. The systems do not reconcile themselves. The application fee amount referenced above is set by CMS each year through a Federal Register notice and is not restated here to avoid quoting a stale figure.

How Credential OS Runs It

From scattered portals to one revalidation board

Credential OS is the payer enrollment platform inside our credentialing stack. It treats every PECOS record and every state Medicaid enrollment as one tracked entity on a shared clock.

01

Register

Every provider, every state, every payer ID mapped to one profile

02

Clock

Each state's cycle and notice window tracked against 42 CFR 455.414

03

Disclose

One current 455.104 ownership record pushed to every state form

04

Alert

Lead-time warnings before the window opens, not after it closes

05

Prove

Audit trail of every submission, fee, and screening result by state

Stop tracking twelve portals in a spreadsheet nobody trusts

If your group bills Medicaid in more than one state, a single silent deactivation can cost more than a quarter of revenue in that market. Credential OS keeps PECOS and every state Medicaid cycle on one board, with the ownership-disclosure record current everywhere at once. Let us show you your own footprint on the map.

Map my enrollment footprint → Talk to a credentialing lead

Sources referenced: CMS Provider Enrollment, Chain and Ownership System (PECOS); 42 CFR 424 Subpart P (Medicare enrollment and 424.515 revalidation; 424.57 DMEPOS; 424.514 fee); 42 CFR 455 Subpart B (455.104, 455.105, 455.106 ownership and disclosure) and Subpart E (455.414 revalidation, 455.436 database checks, 455.450 screening levels, 455.460 application fee); 21st Century Cures Act Section 5005. State portals named as examples: California PAVE, Texas TMHP, New York eMedNY, Pennsylvania PROMISe, Florida FMMIS, Ohio PNM, Georgia GAMMIS, Illinois IMPACT, North Carolina NCTracks, Washington ProviderOne, Michigan CHAMPS. Cycle meters are illustrative and do not represent a specific provider or client schedule.