What Is PECOS Medicare System?

PECOS is the online Medicare enrollment management system

What Is PECOS?

PECOS (the Provider Enrollment, Chain, and Ownership System) is an online platform healthcare providers and suppliers use to submit and manage their Medicare enrollment information. This allows them to register to provide services for patients with Medicare. The only other option for these groups of people is to submit a paper CMS-855 enrollment application. 

PECOS is run by the Centers for Medicare & Medicaid Services (CMS), a federal subagency under the United States Department of Health and Human Services. 

Key Takeaways

• Health care providers and suppliers can use PECOS to enroll in Medicare. 
• To make the enrollment process easier, you’ll want to gather certain documents before beginning.
• Once enrolled, you can use PECOS to change your information, complete your revalidation process, or deactivate your account.

What Is PECOS Used For?

PECOS streamlines the enrollment process for healthcare providers and suppliers that want to offer services to patients enrolled in Medicare. It’s how people like physicians, nurse practitioners, clinical psychologists, and optometrists can get registered to provide care and bill Medicare. PECOS is also used by medical suppliers such as durable medical equipment companies and orthotic suppliers.

The system allows such vendors to: 

• Complete and submit an initial Medicare enrollment application
• Make and submit changes to existing Medicare enrollment information 
• Revalidate enrollment information 
• Track the status of an application 
• Reactivate an existing record
• Withdraw from the program

Using PECOS speeds up the enrollment process. It also helps reduce mistakes, since the system runs an error check before you submit your application. This ensures you can begin providing Medicare services as quickly as possible. 

Note

If you’re not a healthcare provider or supplier, you won’t use PECOS. This article on how to choose a Medicare plan might be more helpful.

PECOS Pre-Enrollment Checklist

To make the application process easier, PECOS provides a checklist of documents you’ll need to gather to provide the required information. 

Here are some of the items on the pre-enrollment checklist:

• Active National Provider Identifier (NPI)
• National Plan and Provider Enumeration System (NPPES) user ID and password 
• Personal Social Security number and date of birth 
• Educational information, such as the name of your school and graduation date 
• Information about your professional licenses, such as the medical license number and state where issued 
• Information about your certification, such as its original effective date, renewal date, and certification number 
• Drug Enforcement Agency (DEA) number 
• Details about any final adverse actions, such as your Medicare billing privileges being revoked or the suspension of your license by any state licensing agency 
• Your medical practice’s legal business name and location 
• Information about how your practice stores medical records 
• Contact information for your billing agency, if applicable 
• Documentation to authorize electronic funds transfers so you can receive Medicare Part A and Part B payments directly

Important

PECOS has three different checklists depending on the type of provider you’re enrolling as. You can find each one here on the PECOS site.

PECOS Enrollment Process

Once you’ve gathered the required documents and information, you can use PECOS to enroll as a Medicare provider or supplier.

Step 1: Navigate to the PECOS Website 

The website looks like this: 

You must log into the system with your User ID and password. If you don’t have login credentials yet, you can register for an account.

Important

Only individual practitioners, authorized or delegated officials for a provider or supplier organization, or individuals who work for providers or suppliers can register. 

Once you log in, you’ll provide information about your identity and services. 

Step 2: Click the “My Associates” Button to Start the Application Process

Here you can: 

• Enroll in Medicare for the first time
• View or make changes to existing Medicare information 
• Keep working on an application that you’ve saved

Step 3: Click on the “New Application” Button

On the next page, you must indicate which provider the application is for. 

Step 4: Select If You’re Enrolling Solely to Order and Refer

If you answer yes, you won’t be sending claims to a Medicare contractor for any service you provide. 

Step 5: Select the Description That Best Matches Your Situation

You’ll indicate whether you’re applying as a:

• Sole owner of a PA, PC, or LLC
• Self-employed/sole proprietor
• Group member only
• Group member and self-employed 
• Disregarded entity 

Then, your identifying information will appear. Make sure your first and last name, Social Security number, and date of birth are correct, and head to the next page. There you’ll enter the state where you practice.

Step 6: Select Primary Medicare Services Rendered

Select your Part B Physical Specialities or Non-physician Specialties in the drop-down menu. 

Note

You must complete separate applications for each primary healthcare service you provide.

Step 7: Begin the PECOS Application

Once you’ve verified the information from the previous steps, it’s time to start the actual application process. 

PECOS has a few features to help keep your application on track.

At the top, you’ll see a progress bar to show you how much you’ve completed. 

Then, there are three different tabs: 

• Topic View
• Fast Track View
• Error/Warning Check 

Let’s look at each one of those more closely. 

• The Topic View is a high-level view of what you need to do before you can submit your application. 
• The Fast Track View makes it simple to move through topics you haven’t yet completed. 
• The Error/Warning Check notifies you of potential problems or missing parts in your application process. 

Step 8: Provide Information for Each Topic and Complete All Required Fields

Keep the documents you gathered earlier nearby so they’re easy to access as you go through the application. 

Once you complete one section, verify that there aren’t any mistakes on the Topic Summary before clicking the “Return to Topics” button at the bottom of the page. 

Complete this process for each topic in the application. Once you verify your information for a specific topic, a checkmark appears on the Topic View checklist. This helps you keep track of what steps you still need to complete.

Submitting Required and Supporting Documentation

PECOS allows you to upload documents to support your application. The drop-down menu allows you to select the document type you want to provide. Then, you choose the correct file from your computer.

Once you’ve attached all your documents, navigate to the Topic View and scroll to the bottom to click “Begin Submission.”

Important

Any documents you don’t upload as part of the application process must be mailed to the fee-for-service contractor that manages Medicare operations in your jurisdiction. This could delay the processing of your application.

Step 9: Electronically Sign and Submit Your Application

Before you submit your application, you must decide whether you’d like to electronically sign and submit your document or mail in a hard copy. You’ll also need to agree to all the terms and conditions.

After verifying that everything is accurate, you can submit your application. If desired, print a copy for your records.

Note

Upon initial enrollment, you must pay a Provider Enrollment Medicare Application Fee. In 2023, it was $688.

Benefits of Using PECOS

Though the application process may seem tedious, using PECOS has several advantages for healthcare providers and suppliers. 

Here are a few of them: 

• Quicker application process: Since PECOS is a digital system, you won’t have to wait for mail delivery to submit your documents or worry about them getting lost. Instead, you submit your application and supporting documents simultaneously, streamlining the process.
• Application status tracking: You can run an online search to check the status of your PECOS application.
• Secure submission of documents: As an official government website, PECOS provides a way to upload and store your documents securely.
• Streamlined revalidation: When it’s time for you to revalidate your information, PECOS makes it simple. You can quickly review and update your information electronically, which can help prevent costly interruptions to your ability to bill Medicare.
• Tailored application process: PECOS uses your information to ensure you fill out only the sections related to you. You won’t have to jump through unnecessary hoops as a part of your application.

Frequently Asked Questions (FAQs)

What Is PECOS 2.0?

PECOS 2.0 is the new and improved PECOS that’s coming soon. It will add additional features and streamline the Medicare enrollment process even further. For example, it will allow you to use a single application to update multiple enrollments, such as practices in different states or primary specialties.

Is It Mandatory to Register With PECOS?

No, registering with PECOS isn’t mandatory. CMS still accepts paper applications. However, PECOS is highly recommended, as it’s paperless and speeds up the application process.

What Is the CMS?

The CMS is the Center for Medicare & Medicaid Services. It administers Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP.) PECOS is overseen by the CMS.

What Is the CMS-855 Enrollment Application?

The CMS-855 enrollment application is the paper application that healthcare providers and suppliers can use to register with Medicare.

How Do I Upload Documents to PECOS?

Uploading a document to PECOS is a simple process. After logging in, navigate to the “Topic View.” The bottom option is “Required and/or Supporting Documentation Information.” From here, you can select the type of document you want to submit, find the file on your computer, and upload it.

The Bottom Line

PECOS is an efficient way for healthcare providers and suppliers to register with Medicare to provide services to participants. While submitting your application through PECOS isn’t required, the advantages of doing so are clear. It’s a streamlined, paperless system that accelerates the application process and makes it simple to review and update your information whenever needed. 

Read the original article on Investopedia.