What is PECOS?

Created by CMS, PECOS stands for Provider, Enrollment, Chain and Ownership System and is a database for physicians who have registered with CMS. The Affordable Care Act requires physicians and other eligible non-physician practitioners (NPPs) to enroll in the Medicare Program to order/refer items or services for Medicare beneficiaries. Medicare will deny claims for services or supplies that require an order/referring provider to be identified, but the provider is not identified, not in Medicare’s enrollment records or is not of a specialty type that may order or refer the service/item being billed.

How to Perform a PECOS Lookup

Staying on top of your PECOS verification is a key step in avoiding Medicare denials. To ensure that a referring physician is enrolled in PECOS, you can perform a PECOS lookup online. HEALTHCAREfirst offers a PECOS lookup tool that provides a way to verify your referring physician against the most recent CMS public-use file to make sure s/he has enrolled before accepting the patient onto your services. Simply type in the physician’s NPI number and you’ll be provided with their current status.

Additionally, prior to submitting the RAP and claim, you will want to match the NPI of the physician, the first four letters of the physician’s last name, and the first letter of the physician’s first name against the Ordering/Referring File.

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