June 18, 2010
Beginning January 3, 2011, the Provider Enrollment, Chain and Ownership System will take effect. The Centers for Medicare & Medicaid Services will deny claims for the ordered, referred services or items billed if:
- The provider does not include a National Provider Identifier on the Medicare and Medicaid enrollment applications and claims;
- If the ordering/referring supplier is not a physician or an eligible professional with an approved enrollment record in PECOS; and
- The provider's legal business name and NPI are not included on claims (only applies to claims for covered, ordered durable medical equipment, prosthetics, orthotics, and supplies, laboratory, imaging, or specialist services).
PECOS Enrollment Required for Medicare Providers
The Center for Medicare and Medicaid Services has established Internet-based Provider Enrollment, Chain and Ownership System as an alternative to the paper enrollment process. Internet-based PECOS will allow physicians, non-physician practitioners, provider, and supplier organizations to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file, or check the status of a Medicare enrollment application via the Internet.
If you enrolled in Medicare or updated your Medicare enrollment information within the past five years, your Medicare enrollment information is stored in PECOS. This is an electronic system in which Medicare contractors enter the Medicare enrollment information that you provided on the Medicare enrollment application.
If you enrolled more than five years ago and have not submitted any updates to your Medicare enrollment information, you will need to update your Medicare enrollment information. Doing so will ensure that your Medicare enrollment information is in PECOS.
How to Enroll in PECOS
Physicians who have not opted out of Medicare need to be enrolled in PECOS by July to continue seeing or referring Medicare patients for most items and services. CMS offers an online enrollment process. Applicants must:
- Have or obtain a National Plan and Provider Enumeration System user ID and password. This is the same system physician practices use to sign up for an NPI.
- Complete, review and submit an electronic enrollment application on the PECOS website.
- Print, sign and date the two-page certification statement; mail it and all supporting paper documentation to a Medicare contractor within seven days of electronic submission.
If you enrolled in Medicare after November 2003, or if you enrolled before November 2003 and have updated your Medicare enrollment information since November 2003, no further action is required.
If you are unsure, here are ways to verify that you have an enrollment record in PECOS:
- Check the Ordering Referring Report on the CMS website. If you are on that report, you have a current enrollment record in PECOS. Go to CMS website, click on "Ordering Referring Report" on the left.
- Use Internet-based PECOS to look for your PECOS enrollment record. (You will need to first set up your access to Internet-based PECOS.) If no record is displayed, you do not have an enrollment record in PECOS. Go to CMS website, click on "Internet-based PECOS" on the left, for information on using Internet-based PECOS.
- Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS. Go to CMS website, click on "Medicare Fee-For-Service Contact Information" under "Downloads."
Note: If you have submitted an enrollment application within the last 90 days, and your enrollment application has been accepted for processing by the carrier or A/B MAC, you need not take any additional actions based on this listserv message.
For additional questions or information on enrollment, physicians can view the CMS "Getting Started Guide for Providers" or contact the ACR practice management department at (404) 633-3777.