PECOS

PECOS stands for Medicare’s Internet based Provider Enrollment, Chain and Ownership System. It replaces the paper CMS-855I and 855R forms. The online process has a quicker turn around time for processing. Usually 45 days rather than 60 for the paper applications. PECOS can be used for initial enrollment or to view or change enrollment information. You can now also track your enrollment application through the submission process, which could not be done previously with the paper form. In addition to enrolling and tracking the application, providers can now change, add or reassign benefits and even withdraw from the program through the system. Just like the paper application process, PECOS needs to be updated whenever there is a Reportable Event that affects information on the enrollment record such as ownership, change in address of practice location, licensure, etc. Changes must be reported within 30 days of a reportable event. A full list of Reportable Events can be found at: www.cms.gov/MedicareProviderSupEnroll.

All providers (Individual Physicians and Non-Physician Practioners) need to complete an online application even if they are currently enrolled with Medicare, with the exception of DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies CMS-855S) which will be available later this year.

PECOS uses the same ID’s and passwords that are established when providers apply online to the National Plan and Provider Enumeration System (NPPES) for their NPI’s. Once the application process is completed online, the system generates a two page Certification Statement. Providers will need to sign the original statement (blue ink is recommended) and mail it to their Medicare contractor within seven days.

If providers do not have established User IDs and passwords they can do so at https://nppes.com.hhs.gov/NPPES. If they have forgotten their passwords or User IDs they can retrieve them by contacting the NPI Enumerator at 800.465.3202 or emailing customerservice@npienumerator.com.

CMS had indicated in addition on enrollment requirements for physicians that claims may automatically start rejecting on July 6th, 2010 if the referring or ordering provider was not enrolled. Many providers and provider organizations have voiced their concerns that their revenue may be interrupted by no fault of their own. Additionally many providers have reported issues with using the online system creating delays in their application approval, which prompted CMS announced in June that it was launching a review of PECOS and has moved back the date that providers need to be enrolled to Jan 3, 2011.