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PECOS: What You Need to Know

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12092020_PECOS

PECOS plays a critical role in facilitating communication and data accuracy between providers and CMS. Though not a monitored source itself, this database powers several datasets indicating providers’ statuses and standing with CMS.

In this post, we provide a quick overview of the PECOS portal and the related datasets that help you answer important eligibility questions about providers in your networks.

What is PECOS?

PECOS stands for Provider, Enrollment, Chain, and Ownership System. It is the online Medicare enrollment management system that allows individuals and entities to enroll as Medicare providers or suppliers. This system also allows you to renew your enrollment, withdraw from the Medicare program, keep your information up to date, report any changes to your enrollment record, and electronically sign and submit all your information. CMS developed PECOS as a result of the Patient Protection and Affordable Care Act. 

How do you search for a provider using PECOS?

The PECOS system is a database of providers who have registered with CMS. A National Provider Identifier (NPI) is necessary to register in PECOS. Use that identifier to search for the provider in the database. 

If you don’t know the provider’s NPI number, you can search for their information in the NPI registry. To quickly screen a provider’s NPI and get additional insight into the provider, use our free NPI Lookup tool.

How do you check whether a provider is enrolled in Medicare?

To find a provider that is enrolled in Medicare, you can search directly through the CMS system. You can also use the Physician Compare Tool provided by Medicare. A provider is required to enroll in the PECOS system and keep their information accurate to continue practicing within the Medicare program.

Can a provider’s PECOS status change over time?

Yes, a provider’s status can change over time. Providers are required to revalidate their information upon renewal. If a provider misses their renewal date or their information changes and supporting documentation is not provided, participation in the Medicare program will no longer be active. A provider’s status with CMS can also be affected by appearing on the Preclusion List or an exclusion source.

Who manages PECOS?

The PECOS system is managed and maintained by the Centers for Medicare & Medicaid Services (CMS). The PECOS applications are processed electronically, allowing for an efficient and data-protected process.

What is the role of Medicare Administrative Contractors? 

Medicare Administrative Contractors manage Medicare operations for provider enrollment. They are assigned by state or jurisdiction. They can answer enrollment questions and process enrollment applications. 

Medicare Opt-Out

If a physician or provider decides not to be included in the Medicare program, they must submit an affidavit to the Centers for Medicare and Medicaid Services (CMS). Information on these providers is published through the Provider Enrollment, Chain, and Ownership System (PECOS) from CMS and is updated monthly.

Who must register in PECOS?

  • Physicians and Specialists
  • Registered Nurses
  • Physician Assistants
  • Certified Clinical Nurse Specialists
  • Nurse Practitioners
  • Clinical Psychologists
  • Certified Nurse-Midwives
  • Clinical Social Workers
  • Physicians employed by the Department of Veterans Affairs, the Public Health Service, or the Department of Defense/Tricare (must use CMS FORM 855O)

What will happen if a provider doesn’t register in PECOS?

Any claims for items or services that a provider has prescribed will be denied if they are not in the PECOS system. This applies to Medicare claims only. Not having current and active enrollment with CMS will make it difficult for patients to receive the items they need and will prevent or delay claims processing.

What sources should I be monitoring in relation to PECOS? 

The the PECOS database is updated on a weekly basis. Confirm the enrolled status of providers via the Medical Provider and Supplier file. It is also important to monitor providers’ NPI status and the Preclusion List.

Does ProviderTrust offer monitoring of Medicare Opt-Out?

Yes, Medicare Opt-Out can be added to any exclusions or license monitoring package. We recommend combining Opt-Out and NPI monitoring with exclusion monitoring and ongoing license verification to ensure your organization has the full picture of a provider’s standing with CMS and billing eligibility.

ProviderTrust offers instant screening and ongoing monitoring for your provider networks. Verify provider standing and eligibility in key workflows and get continued peace of mind as long as the relationship continues.

It's time for smarter provider network monitoring.

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