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Vermont Medicaid
Vermont Medicaid, revalidated on time
An active Vermont Medicaid enrollment, an off cycle revalidation finished by its due date, and claims that stay paid.
Vermont is revalidating its high risk providers and a group of moderate risk ones off cycle, with notices through early 2027 and a plan that runs to June 5, 2028. A provider that misses its due date loses its enrollment. The Department of Vermont Health Access runs Vermont Medicaid and posts the plan on its Medicaid provider revalidation strategy page.
Off cycle revalidation
About 300 high risk and selected moderate risk providers are being revalidated off cycle, with notices 90 and 45 days before the due date. Vermont DVHA, Medicaid provider revalidation strategy
Missed due date
The Vermont Medicaid enrollment is terminated, and reinstatement takes a new enrollment application. Vermont DVHA, Medicaid provider revalidation strategy
Supervisees
Since January 1, 2026, every supervisee under behavioral health supervised billing must be enrolled with Vermont Medicaid. Vermont DVHA, supervised billing
Retroactive start
From June 1, 2026, a new enrollment can request an effective date up to 90 days back, with no separate form. Vermont Medicaid General Provider Manual, October 2026
Ordering and referring
Ordering, prescribing, referring and attending providers and residents must be enrolled as participating providers. Vermont Medicaid General Provider Manual, October 2026
What we see in practice
45 to 90 days from submission to an active Medicaid ID.
In the official words
Providers who fail to submit and complete their revalidation by the due date will have their Vermont Medicaid enrollment terminated.
Once terminated, reinstatement will require the submission and approval of a new Medicaid enrollment application.
Vermont is revalidating high risk providers off cycle
In response to a federal request, Vermont Medicaid is running an off cycle revalidation of the providers it rates high risk and a subset of those it rates moderate risk, about 300 providers in all. Gainwell Technologies contacts each affected provider. Vermont DVHA, Medicaid provider revalidation strategy
The June 2026 strategy counts about 150 high risk service locations: nursing facilities, home health agencies, hospice providers and DMEPOS vendors, plus any provider raised to high risk over a credible allegation of fraud, waste or abuse. The first group's 90 day notices were set for July 1, 2026 and the second group's for August 1, 2026, and the state expected to finish this group by December 31, 2026. Vermont Medicaid two year provider revalidation strategy, June 2026
About 140 moderate risk service locations come next, with notices scheduled for January 1, February 1 and March 1, 2027. This group is nursing facilities, home health agencies, hospices and DMEPOS vendors whose risk level dropped at an earlier revalidation, and it leaves out providers revalidated in the preceding 12 months. The strategy says all off cycle revalidations will be completed by June 5, 2028, and that Vermont will limit new DMEPOS supplier enrollment to entities already enrolled with Medicare. Vermont Medicaid two year provider revalidation strategy, June 2026
These waves sit on top of the regular cycle. Federal rules require every provider to be revalidated at least every 5 years. 42 CFR 455.414
How enrollment works, step by step
- Enroll every clinician whose name goes on a claim. Ordering, prescribing, referring and attending providers and residents must be enrolled as participating Vermont Medicaid providers. Vermont Medicaid General Provider Manual, October 2026
- Sign the provider agreement in ink. Stamped, faxed or copied signatures are not accepted, and an application with signatures that are not original is not processed. Vermont Medicaid General Provider Manual, October 2026
- If care started before the application, ask for the earlier date on the application itself. Since June 1, 2026, a new enrollment or reenrollment can request an effective date up to 90 days before the complete application is received and accepted, and screenings, credentials and documents must cover that whole period. Vermont Medicaid General Provider Manual, October 2026
- For a date 90 to 180 days back, an actively enrolled provider sends a Retroactive Enrollment Request Form within 90 days of the enrollment approval. An approved retroactive date still does not guarantee payment for that period. Vermont Medicaid General Provider Manual, October 2026
Vermont makes no payment until a provider number is assigned and rejects an enrollment when mandatory information is missing Vermont Medicaid General Provider Manual, October 2026, so a Vermont application sits on our calendar at 45 to 90 days from submission to an active Medicaid ID.
Behavioral health supervisees now enroll in their own name
The Department of Vermont Health Access updated its supervised billing rule for behavioral health, HCAR 9.103, effective January 1, 2026. Under the new version all supervisees must enroll with Vermont Medicaid, and enrollment for supervisees opened on October 1, 2025. Vermont DVHA, supervised billing
A supervisee enrolls under the provider type that matches the license being worked toward. On the claim the supervisor is the billing provider and the supervisee is the rendering provider. Vermont Medicaid Supervised Billing Manual, 2026
Two cases do not pay. Services by a provider who is licensed but not enrolled with Vermont Medicaid cannot be billed under supervised billing, and for a supervisee who has applied for a license and is waiting on it, DVHA expects the practice to hold claims until licensure is approved. Vermont Medicaid Supervised Billing Manual, 2026
Where Vermont enrollments lose money
The state's provider management system inactivates and disenrolls a provider that does not finish revalidation within 30 days of its due date. In calendar year 2025, 828 provider service locations were terminated for late revalidation. Vermont Medicaid two year provider revalidation strategy, June 2026
The cost reaches backward. A provider that revalidates late faces disenrollment and claim recoupments back to the date of disenrollment, and coming back takes a new application with full screening. Vermont Medicaid two year provider revalidation strategy, June 2026
An enrollment that goes quiet closes as well. The system disenrolls providers after three years without claims, and in 2025 that removed 1,518 provider service locations. Vermont Medicaid two year provider revalidation strategy, June 2026
Check where you stand before you submit
WeBill Health runs Revenue Velocity Credentialing with 24/7 CAQH and PECOS lifecycle monitoring, so revalidation dates and affiliation gaps are caught before they become suspended claims. Every file gets Human Expert Review from a credentialing specialist before it goes to the Department of Vermont Health Access.
Revenue Velocity Credentialing
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