PECOS (Provider Enrollment and Chain/Ownership System)
Q: How do I know if I need to enroll in the Medicare PECOS (Provider Enrollment and Chain/Ownership System) or if I am already enrolled in PECOS?
A: You need to be enrolled in PECOS (pronounced “pay-cose”) if:
- You participate in Medicare or do not participate in Medicare but see Medicare patients. (See “Medicare” under the Definitions tab above for additional explanation of the difference.)
- You write prescriptions or orders for durable medical equipment (walkers, canes, crutches, etc.), prosthetics or supplies for Medicare patients, even if you have opted out of Medicare and do not receive payments from Medicare. A list of provider types is here:
- ”¢ doctor of medicine or osteopathy
”¢ doctor of dental medicine
”¢ doctor of dental surgery
”¢ doctor of podiatric medicine
”¢ doctor of optometry
”¢ doctor of chiropractic medicine
”¢ physician assistant
”¢ certified clinical nurse specialist
”¢ nurse practitioner
”¢ clinical psychologist
”¢ certified nurse midwife
”¢ clinical social worker
- You are a mid-level provider who does not bill Medicare under your own name/billing number, but who does write prescriptions or orders for durable medical equipment and/or refer patients to other providers.
If you want to check and see if you are already enrolled in PECOS, a downloadable file is available here (12,000 pages!) and everyone listed in this Ordering/Referring file has approved enrollment status. Anyone not appearing on this list is not in approved status, or has opted completely out of the Medicare program (see note below.)
NOTE about physicians/non-physician practitioners who have opted-out of Medicare but who order and refer: Physicians and non-physician practitioners who have opted out of Medicare may order items or services for Medicare beneficiaries. Their opt-out nformation must be current (an affidavit must be completed every 2 years, and the NPI is required on the affidavit). Opt-out practitioners whose affidavits are current should have enrollment records in PECOS that contain their NPIs.
My posts on PECOS are here:
Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)
My Notes from the CMS Open Door Forum on May 19, 2010: PECOS, DMEPOS and Blue Ink on Paper Forms