PECOS stands for Provider Enrollment, Chain and Ownership System and is the database that Medicare uses to help enroll providers and suppliers. As a provider, you can use PECOS to enroll in the Medicare program, renew your enrollment, withdraw from the program or update your information on file with Medicare. You can also use PECOS to look up information about other providers. This blog post will help you better understand what you can do on PECOS, how to use it and what information you need to get started.
What is Pecos?
PECOS is an online lookup system that lets you find providers enrolled in Part A and Part B of Medicare. The data you can view includes provider or supplier ID numbers (NPI), name, address, specialty and contact information. You also can search by their city, state or ZIP code to find specific information about a particular provider or supplier.
What does Pecos mean in healthcare?
PECOS stands for Provider Enrollment, Chain and Ownership System. It's an online tool used by Centers for Medicare & Medicaid Services (CMS) to collect provider data. It is especially useful in identifying providers who are affiliated with specific hospitals or health systems (and vice versa). PECOS can also be used to help determine which hospitals participate in certain federal programs. For example, if you're applying to participate in CMS' Hospital Value-Based Purchasing Program (VBP), Pecos is one of three data sources you must query using specific criteria.
Who Can Use PECOS?
Any individual or entity that is currently enrolled in, looking to enroll in, or interested in withdrawing from Medicare can use PECOS. Physicians, health care professionals, suppliers of medical goods and services, and pharmacies are all able to log into PECOS at various times throughout their enrollment cycle. Physicians may even need to access certain information more than once while using PECOS, so it’s important to know what each tool offers. When you go to login for your first time, you’ll have three choices: Create an account - If you are new user to Medicare's enrollment system. Review your enrollment record - If you are currently enrolled but want additional information on how your practice is registered with CMS.
Can I view PECOS information if I am not enrolled?
NPI Dashboard has a PECOS lookup tool where anybody can search our copy the PECOS database. Searches can be made based on name, state or NPI number. The search will display the enrollment status as well as the PECOS codes.
Only physicians and certain other eligible professionals are eligible to order or refer items or services for Medicare beneficiaries. Claims edits were implemented to check the following claims for an approved enrollment and valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid:
DME — Eligible to order/refer Durable Medical Equipment (DME) - Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for ordered DMEPOS
HHA — Eligible to order/refer Home Health Agency (HHA) - Claims from Part A Home Health Agencies (HHAs)
PMD — Eligible to order/refer Power Mobility Devices (PMD) - Claims from Power Mobility Devices (PMD)
What is the purpose of Pecos?
PECOS is a lookup tool that allows individuals and agencies to see if an entity has previously been enrolled in Medicare and, if so, what entity received payments under that previous enrollment. It also allows providers/suppliers to query information about themselves or an individual related to their practice. Additionally, it provides a mechanism by which providers/suppliers can withdraw from participation in (or choose not to participate in) Part A or Part B of Medicare as well as enroll as a provider or supplier. The online CMS (Centers for Medicare & Medicaid Services) tool that enables providers and suppliers to enroll in or revalidate (renew) their enrollment as a provider or supplier in Medicare. In addition, you can use PECOS to withdraw from the program or update your information with CMS.
How do I know if I have Pecos?
PECOS stands for Provider Enrollment, Chain and Ownership System. It's an online CMS (Centers for Medicare & Medicaid Services) tool that enables providers and suppliers to enroll in or revalidate (renew) their enrollment as a provider or supplier in Medicare. In addition, you can use PECOS to withdraw from the program or update your information with CMS. If you have questions about Pecos, please feel free to call your local district office at 1-800-MEDICARE (1-800-633-4227). Or, check out their website which has a handy Look Up option on their main page that allows you to enter your current information and it will pull up your personal Pecos ID.
Why do I need a Pecos number?
Enroll in and manage your enrollment with PECOS at any time. Revalidate (renew) your enrollment. Withdraw from the Medicare program if you no longer wish to provide care to beneficiaries. Review and update personal information, such as citizenship status or office locations. Visit https://pecos.cms.hhs.gov/pecos/login.do or call 800-318-2596 for more information on how you can leverage PECOS to enroll, revalidate, withdraw from Medicare, and update information about yourself and your practice, if applicable.
What is the difference between Pecos and Nppes?
NPPES is where providers and suppliers log in to see their enrollment status with CMS, which includes information like if they are enrolled, their provider or supplier type, their Group Number (GN), etc. This information can be found on PECOS; however, Pecos also has additional functionality that NPPES does not have. On Pecos you can look up other providers/suppliers by their address or EIN (their 9 digit Tax ID number). You can also renew your enrollment on Pecos (with specific instructions on how to do so based off of your provider type) instead of having to go through NPPES. These functions allow you to conduct business-to-business transactions with other enrolled providers/suppliers through both systems.
Is Pecos number same as NPI?
Yes. PECOS information is linked to NPI number. This means you can find out important details about providers by simply looking them up on Pecos. The first step is usually to search by provider name or NPI number. You can look up multiple providers at once by doing a batch search on an entire database of providers, which you would do by ZIP code or state/territory.
How do I verify my Medicaid provider online?
If you are already enrolled as a provider or supplier, please login. If you need to revalidate (renew) your enrollment please click on Renew Enrollment and enter your user ID and password. You will then be prompted to complete and submit an application via PECOS. You may logout at any time after submitting your application and will receive an email confirmation upon successful submission of your enrollment information. During processing, you may check your status by logging in again to see if there is a case number displayed under My Status. It can take 3-5 business days from receipt of all necessary information before you receive a response regarding your enrollment request.
How do you become Pecos enrolled?
You have two ways to become enrolled in PECOS. You can enroll online or by mail using Form CMS-855A, Application for Enrollment in PECOS. Visit PECOS enrollment to learn more about these options. What is a Pecos reference number? The fee schedule has many codes that have different levels of payment or no payment at all. There are also provider types, quality programs and services with specific payment rules.
How do I find a CMS certification number?
If you already have a CMS certification number, you can find information about your certification by doing a lookup in eCMS under Provider Enrollment and Membership (PEM) as follows: Log into eCMS. Select Provider Enrollment and Membership (PEM) from under Enrollments. Under Lookup, select Certification #. Enter your certification number and click search.
How long does it take to get Pecos certified?
To apply for certification, you’ll need to submit a PECOS registration application through CMS. Depending on whether you’re applying as a Supplier or Provider, it can take anywhere from 24 to 48 hours to get an approval email back in your inbox. You can verify your status by logging into PECOS and looking at My Account. If your information is still listed as pending, it's likely that there's something incorrect with your application. Once everything has been verified, Pecos will send an email letting you know that you've been approved and are ready to start billing patients or submitting claims online.
What is a non participating Medicare provider?
Non-participating providers are required to file claims, and they will be paid by Medicare. They cannot accept assignment of their claims (that is, they cannot bill on behalf of a third party payer such as a private insurer). Non-participating providers may not be reimbursed in full for all services, and may have to reimburse Medicare for payment of some part B services that might otherwise have been covered by a third party payer. In addition, they do not have access to most of Medicare's non-claims program features. Generally speaking these requirements will apply only if your practice accepts new patients who have coverage under Parts A or B.
Can you bill a Medicare patient if you are not a participating provider?
It’s possible to bill a patient if you are not a participating provider in Medicare. However, your patient will be responsible for paying their coinsurance amount or deductible, plus any additional charges they incur. This would be considered an out-of-network claim. Typically, these claims are denied by most insurance companies and you may need to pursue collections through Small Claims Court if your patient refuses to pay their share of costs. If they paid any part of an in-network benefit, however, you’ll receive payment from your patient’s insurance company once they file an in-network claim—provided that no other exclusions apply.
What does a participating provider mean?
A participating provider or supplier means a provider or supplier that has been authorized by CMS to provide items and services and receive payment under Medicare. You must be a participating provider to enroll in and/or submit claims to Medicare. Learn more about how providers become enrolled in PECOS.
What are the advantages of a participating provider?
Participating providers will no longer need to complete enrollment forms each year; all enrollment-related tasks are done electronically via PECOS. Participating providers can take advantage of CMS’s registration fee waiver program. Participating providers can take advantage of CMS’s Data Universal Numbering System (DUNS) number waiver program. Participating providers may have improved ability to opt-out or opt-in to parts of Medicare services in the future. Participation in PECOS is required for all new enrollments beginning with 2015 billing cycles, so you may want to consider completing your enrollment now in order to avoid potential penalties in future years when it will be mandatory.
The Centers for Medicare and Medicaid Services (CMS) unveiled a new online enrollment management system that allows healthcare providers to maintain their participation in Medicare as either a provider or supplier. Using PECOS, providers will be able to enroll, revalidate (renew), withdraw from and update their information via an interactive website. Additionally, CMS will be providing training sessions and user guides for both current and future users of PECOS.