Are You Enrolled in Medicare PECOS?

Physicians, non-physician practitioners, and other suppliers that refer, order or submit claims for Part B items or services MUST be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS). CMS has developed and successfully tested an edit that identifies claims that either fail to identify the referring practitioner or referring practitioners that are not in the PECOS database and, thus, are not qualified to refer for Part B services.

The implementation date is January 6, 2014.

There are three ways to verify that you have an enrollment record in PECOS:

• Check the Medicare Provider Enrollment on the CMS website.
  • If you are listed on that report, you have a current enrollment record in PECOS.
• Use Internet-based PECOS to look for your PECOS enrollment record.
  • If no record is displayed, you do not have an enrollment record in PECOS.
• Contact your Noridian (NAS) Medicare enrollment and ask if you have an enrollment record in PECOS.
  • Telephone number is (877) 908-8431 Monday through Friday between the hours of 9:00 a.m. to 5:00 p.m. Central Time, excluding holidays.

If you are not yet in PECOS, the best way to submit your application is through Internet-based PECOS.. 

Medicare Opt out Application

The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program in order to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. The Centers for Medicare & Medicaid Services (CMS) permits such physicians or other eligible professionals to enroll in the Medicare program for the sole purpose of ordering or referring items or services for Medicare beneficiaries. The submission and approval of a completed, CMS-855O form or its internet-based PECOS equivalent will register/enroll the physician or other eligible professional in the Medicare Program for the sole purpose of ordering and referring specific services for Medicare beneficiaries.

Physicians or other eligible professionals who have opted out of Medicare can apply for PECOS enrollment for the sole purpose of ordering and referring items and/or services to Medicare beneficiaries using either:
• The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or
• The paper enrollment application process (CMS-855O). The CMS-855O is available at http://www.cms.gov/cmsforms/downloads/CMS855O.pdf on the CMS website.

For additional information regarding the Medicare enrollment process, including Internet-based PECOS, go to http://www.cms.gov/MedicareProviderSupEnroll on the CMS website.
Note:  You must obtain a National Provider Identifier (NPI) prior to enrolling in Medicare. Your NPI is a required field on your enrollment application. Applying for the NPI is a separate process from Medicare enrollment. To obtain an NPI, you may apply online at https://NPPES.cms.hhs.gov on the CMS website.

Questions?  Contact Provider Enrollment, (877) 908-8431