PECOS facilitates Medicare Provider and Supplier enrollment by allowing registered users to securely and electronically submit and manage Medicare enrollment information. PECOS, which stands for Provider, Enrollment, Chain, and Ownership System and was developed by CMS, is a database for physicians who have registered with CMS. To order/refer items or services for Medicare beneficiaries, the Affordable Care Act requires physicians and other eligible non-physician practitioners (NPPs) to enroll in the Medicare Program.
- Medicare will deny claims for services or supplies that require the identification of an order/referring provider, but the provider is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may order or refer the service/item being billed. PECOS requires the following professionals to register:
- Physician Assistants (PAs)
- Clinical Nurse Specialists (CCNS)
- NPs (Nurse Practitioners)
- Clinical Psychiatrists
- Certified Nurse-Midwives (CNMs)
- Clinical Social Workers (CSWs)
If you are not enrolled in the PECOS system, any claims for items or services that you have prescribed will be denied. This only applies to Medicare claims. Being unable to access the PECOS system will make it difficult for your patients to receive the items they require and will prevent/delay hospital discharges. You may also have previously prescribed items that are currently being rented. These items can be three years or older (oxygen for example). These claims will also be denied if you are not a PECOS member.
Benefits of Collaborating with us
The ability of a doctor to practice medicine is dependent on having the proper credentials. Patients expect their doctors to provide high-quality care, and one way to ensure that happens is through medical credentialing. In order to keep premiums low, insurance companies will only offer discounts to practitioners who can demonstrate their expertise in their fields.
Patients are safeguarded.
Credentialing in the medical field is also advantageous to patients because it ensures that all doctors and medical practices have the necessary skill sets to carry out any necessary treatments. When patients are cared for by professionals with extensive experience in the field, medical errors are significantly less likely to occur. As a result, patients have more trust in their doctors and their medical methods.
Revenue that isn’t being earned should be reduced
Credentialing in medicine not only protects patients, but it also assists medical practices in maintaining their earnings. Credentialing reduces the likelihood of revenue losses in practices as a result of reimbursements being denied or delayed.
Insurance companies may be able to backdate compensation for treatments if medical practices allow physicians to provide services before the credentialing process begins.
Increase the Number of Patients on Your List
With the help of physician credentialing, medical practices can now reach previously unreachable patient populations. As a result, medical clinics may be able to attract more patients and potentially increase revenue.
It’s time to boost your medical practice’s reputation
Patients are curious about the procedures used by their healthcare providers. They will investigate any healthcare facility that they are considering. If you use medical credentialing, your medical practice’s web reputation will improve. As a result, more people will feel at ease doing business with you.
How to do a Pecos lookup
Maintaining your PECOS verification is a critical step in avoiding Medicare denials. There are numerous websites that provide a free PECOS lookup tool. You can use these tools to check your own and referring physicians’ PECOS enrollment. Simply enter the physician’s NPI number to find out their current status.
Pre-enrollment checklist for Pecos
Before you begin PECOS registration, ensure that you have all of the information CMS requires. The checklist below details all of the information and documents you will need to successfully complete enrollment.
- National Provider Identifier (NPI) (NPI)
- ID and Password for the National Plan and Provider Enumeration System (NPPES)
Personal Identifying Factors
- Formal name
- The birthdate
- Number of Social Security
Information on Education
- Name of the school
- Year of graduation
Information on Professional Licenses
- Number of a medical license
- Original start date
- Date of renewal issued by the government
Information on Certification
- Number of certifications
- Original start date
- Date of renewal issued by the government
- Information on Specialty/Secondary Specialty
- Number of the Drug Enforcement Administration (DEA)
- Information on Subsequent Adverse Events (if applicable)
- Information on Practice Locations
- Location of a Medical Practice
- Particulars about payment
- Data on medical record storage
Information about the billing agency (if applicable)
- Professional licenses, certifications, and/or registrations required by federal, state, and/or local governments
- Documentation for Electronic Funds Transfer
Pecos application process
- Check that you have all of the documents and information listed in the Pre-Enrollment Checklist.
- Click the “Register for a user account” link on the right.
- When asked if you want to register and create a PECOS account, select “yes.”
- Following that, you will see the terms and conditions. Click “accept” if you agree.
- You will be asked to sign up as a user. Enter your email address here. Fill in the image text. Then press the “submit” button. If you need help with your PECOS registration, there are several video tutorials and a user guide on this page.
- After completing your registration, you should print, sign, and date the two-page Certification Statement, which is available at the end of the online application.
- Within seven days of electronic submission, mail the signed Certification Statement, along with supporting documentation, to your designated Medicare contractor.
Which PECOS Sources Should Be Watched?
The PECOS database is updated every two weeks. Consult the Medical Provider and Supplier file to confirm a provider’s enrollment status. It is also critical to keep track of the status of the National Provider Identifier (NPI) and the CMS Preclusion List.
Who Required to Register for PECOS?
To receive reimbursement, all physicians and practitioners who provide Medicare services to beneficiaries must enroll in PECOS. Among these service providers are:
- Specialists and Doctors
- Licensed Practical Nurses
- Physician Assistants (PAs)
- Clinical Nurse Specialists (CCNS)
- NPs (Nurse Practitioners)
- Clinical Psychiatrists
- CNMs (Certified Nurse Midwives)
- Clinical Social Workers (CSWs)
Physicians who work for the Veterans Administration, the Public Health Service, or the Department of Defense.