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State Medicaid agencies are federally required to revalidate the enrollment of all enrolled providers at least every 5 years (see
42 CFR §455.414). This requirement:
When it is time for revalidation, we will send enrolled health care providers a notice, using the Mail-to address listed in our system for the health care provider.
Complete and return the form(s) listed below
only for the provider listed on the notice. OHA must receive the form(s) by the due date listed on the notice.
Only complete these forms if OHA has sent you a revalidation notice asking you to do so. If you have questions about which forms to complete, please email
Behavioral Health Personal Care Attendant providers (only): Complete the OHA 2521 and OHA 3975.
All other individual providers: Complete the OHP 3113 and OHA 3975
Complete the following forms:
The file below lists providers who need to submit revalidations, and providers whose enrollment was inactivated due to revalidation.
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