Effective July 6, 2010, if the ordering/referring provider on the claim is not listed in PECOS, the claims will not be paid by Medicare. Patients may not be able to obtain their medical items they need, they may have problems with rented items and hospital discharges my be delayed.
What is PECOS?
PECOS stands for the Provider Enrollment and Chain/Ownership System. It was created by CMS as an electronic portal for Medicare enrollment.
PECOS is designed to electronically:
- Enroll in the Medicare program
- Make changes to Medicare enrollment information
- View existing Medicare enrollment information
- Withdraw from the Medicare program
- Check the status of an Internet-submitted Medicare enrollment application
Are there any limitations to PECOS versus paper enrollment?
Providers cannot use PECOS to:
- Change name or Social Security Number or Tax ID
- Change an existing business structure or changes in Legal Business Name
- Reassign benefits to another supplier if that supplier does not have a current Medicare enrollment record in PECOS
What are reportable events and what are the timeframes to report such events?
A reportable event is any change that affects information in a Medicare enrollment record. A reportable event may affect claims processing, claims payment, or a provider's eligibility to participate in the Medicare program.
Providers are required to report the following changes within 30 days of the following reportable events:
- Change in ownership
- Change in practice location, and
- Final adverse action
Providers are required to report the following changes within 90 days of the following reportable events:
- Change in practice status (e.g., retirement, voluntary surrender of medical license or voluntary withdrawal from the Medicare program)
- Change of business structure, Legal Business Name or Taxpayer ID
- Banking arrangements or payment information
- A change in the correspondence or special payments address
Who needs to enroll in PECOS?
- Providers who have enrolled with Medicare for more than 6 years
- Providers who have not submitted any updates or changes in more than 6 years
- Providers who have currently enrolled in the Medicare program but have not submitted a complete Medicare enrollment application since November 2003
Although providers could still file paper enrollment applications when applying to Medicare, PECOS takes 45 days to process; paper enrollment applications could take 60 days to process.
to see if your name is listed in PECOS.