There are two ways to enroll with the Medicare program. First, complete the appropriate Medicare paper applications, or second, use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). PECOS supports the Medicare provider and supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information.

PECOS stands for Provider, Enrollment, Chain and Ownership System. It is a database where physicians register with the Centers for Medicare and Medicare Services (CMS). CMS developed PECOS as a result of the Patient Protection and Affordable Care Act. The regulation requires all physicians who order or refer home healthcare services or supplies to be enrolled in Medicare.

If you are one of these professionals then you must register with PECOS: Physician Assistants, Certified Clinical Nurse Specialists, Nurse Practitioners, Clinical Psychologists, Certified Nurse-Midwives, Clinical Social Workers. Any claims for items or services that you have prescribed will be denied if you are not in the PECOS system. This applies to Medicare claims only.

Not being in the PECOS system will make it difficult for your patients to receive the items they need and will prevent/delay hospital discharges. Also, you may have previously prescribed items that are being rented. These items can go back three years or more (oxygen for example). These claims will also be denied if you are not registered with PECOS.

PECOS Pre-Enrollment Checklist

Before you begin registration in the PECOS, make sure you have all of the information CMS requires. The checklist below details all of the information and documents you will need to complete enrollment successfully:

  • National Provider Identifier (NPI)
  • National Plan and Provider Enumeration System (NPPES) ID & Password
  • Personal Identifying Information i.e., Legal name, Date of birth, and Social Security number
  • Schooling Information like, School name, and Graduation year
  • Professional License Information i.e., Medical license number, Original effective date, Renewal date, and State issued
  • Certification Information i.e., Certification number, Original effective date, Renewal date, and State issued
  • Specialty/Secondary Specialty Information
  • Drug Enforcement Agency (DEA) Number
  • Electronic Funds Transfer Documentation
  • Information About Final Adverse Actions (if applicable)
  1. Practice Location Information
  2. Medical practice location
  3. Special payment information
  4. Medical record storage information
  5. Billing agency information (if applicable)
  6. Any federal, state, and/or local professional licenses, certification and/or registrations required for practice

PECOS Enrollment

After you login to the PECOS system, you will be guided through a series of steps to select the appropriate application and enter your information. Similar to selecting the appropriate paper application, it is important to select the proper enrollment type within the PECOS system so that you transfer the appropriate information to Medicare for your enrollment record. An individual physician enrolling with Medicare for the first time can expect to spend an hour or more completing the application and uploading all relevant supporting documents.

Upon completion of the application, you can eSign your enrollment application and upload documents that are required for your enrollment record. After you complete all data entry, eSign the application, and upload all relevant documents, you can finally submit your application online. When submitted via PECOS, your application is sent to the Medicare Administrative Contractor (MAC) for your state.

Most MAC’s complete the application within 60 days, but there is certainly no set turnaround time. After submitting your application via PECOS, you can check the status of your application online directly with the MAC through their website or via the PECOS application status check page.

Suggested Links:

For enrollment:

If you don’t know your NPI:

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Published By - Medical Billers and Coders
Published Date - Jan-05-2021 Back

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