Intelligent Insights

GET STARTED WITH PECOS FOR ONLINE MEDICARE PROVIDER ENROLLMENTIf you’re not using CMS’ Provider Enrollment, Chain, and Ownership System (PECOS) as an alternative to the paper process (CMS-855 form) to enroll providers or supplier organizations into Medicare, you’re missing out on automation that provides multiple advantages, including speed.

CMS cites a 60-day turnaround for a completed provider application using the 855 form, as long as no site visit is needed. Using PECOS online, the turnaround is 45 days with the same site visit stipulation. PECOS’ advantages also include helping you:

• Move toward a paperless process

• Gain control by enabling your department or enrollment function to work on behalf of a provider

• Easily check data, make changes, or voluntarily unenroll providers from Medicare on your time 24/7

• Bring in provider revenue faster by decreasing wait times for back and forth communication or questions and responses

Using PECOS, you’ll still enroll providers through a Medicare Administrative Contractor or MAC—the intermediary private healthcare insurers that CMS has awarded one or more U.S. geographic jurisdictions—to manage the enrollment of providers and processing of claims.

Any fee-for-service provider can be enrolled through PECOS. Institutional providers initially enrolling, revalidating, adding a practice location, or noting a change of ownership in PECOS pay a fee of $586 (2019 rate). And while you’ll truly use one account for the process, you’ll actually use three different systems operated by CMS/Medicare to fully conduct Medicare provider enrollment online. Learn each system’s role in helping you enroll for a smoother initial process and to assist with questions or roadblocks you might encounter once you’re up and running.

The Identity & Access Management (I&A) System is where to designate an Authorized Official (AO). This person can be an individual working on providers’ behalf in the systems.

The National Plan and Provider Enumeration System (NPPES) designates National Provider Identifiers (NPIs) to physicians and non-physician practitioners.

Provider Enrollment, Chain, and Ownership System (PECOS) is where you’ll enroll providers and/or supplier organizations in Medicare.

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Before starting in I&A, NPPES & PECOSThere isn’t a lot of prep to do before jumping into PECOS but gathering provider data and items you’ll need upfront saves time.

Have on hand the provider’s or supplier organization’s Taxpayer Identification Number or Employer Identification Number (note: these are indeed the same number).

Determine which individual will be the Authorized Official (AO) in CMS’ Identity & Access Management (I&A) System. This person may work on providers’ behalf in the systems and will be able to authorize Delegated Officials (DOs), surrogates, and staff end users to use PECOS. Individual providers don’t need to assign an AO but can authorize surrogates and staff end users to work in PECOS. If you don’t have an I&A System account, create a user name and password here.

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Role Represent and Organization Manage Staff

Approve/Manage

Connections

Act on behalf of Individual or Organizational

Providers

Individual Provider Yes Yes Yes Yes

Authorized Official Yes Yes Yes Yes

Delegated Official Yes Yes Yes Yes

Staff No No No Yes

Surrogate No No No Yes

Have on hand (or apply for) the necessary NPIs in NPPES. If you’re not sure whether the provider has an NPI, there’s a free registry where you can check. Your I&A System user name and password can be used to log into NPPES to register for an NPI. All Medicare provider enrollees must have an active NPI.

Because PECOS users can’t mail documents requiring a signature, be prepared to provide an e-signature or upload signed documents.

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Once in PECOSThe same provider information is required whether enrolling in Medicare using PECOS or a paper enrollment application. Missing or incorrect elements in the application will cause delayed enrollment and/or payment. The chart to the left from CMS pinpoints the common pitfalls.

Based on the provider’s type, additional information may be required in PECOS:

• Provider personal identifying information including legal name on file with the Social Security Administration, Social Security Number, NPI, and date of birth

• A resume or CV

• Three professional references including name, specialty, and phone number

• Specialty and secondary specialty information

• Bank account information

• Medical malpractice insurance information for the last 10 years

• Information about any relevant final adverse actions (e.g., revocation of billing privileges; a suspension, termination, or revocation of a license; a conviction of a federal or state felony, etc.)

• Tax Identification Number of the provider or supplier organization

• Education and professional information (e.g., school degrees, internships, residencies, fellowships) including month and year of start and completion

• Federal, state, and local (city or county) business and professional licenses, certificates, registrations (e.g., state license, DEA, CDS, board certification)

• Accreditation information

• Surety bond information

• Legal business name of the provider or supplier organization and current medical practice location

ResourcesCMS provides an extensive self-help page for PECOS, which includes a self-service kiosk to view the status of an application submitted within the last 90 days, a means to pay application fees online, provider checklists, video tutorials for enrolling, and more.

Medicare’s rules for enrollment and revalidation are subject to change, meaning that enrollment specialists or credentialers tasked with these duties could easily miss procedural updates and changes if they don’t regularly review communication from CMS. In addition to missed revenue, errors can result in fines, unenrollment, reduced revenue, and administrative headaches for your department. For these purposes, the Medicare Learning Network is a good resource to visit frequently.

Last but not least, refer to CMS’ National Provider Enrollment Conference PDF overview showing a global view of the PECOS process for more information when learning PECOS.

Tracking and managing updates in the broad arena of medical credentialing and payer enrollment data is time-consuming, requiring strict attention to detail to avoid costly oversights and errors. Use all the software tools at your disposal to automate and streamline your workflow.

Call IntelliSoft today for a demonstration: 888-634-4464 or email sales@intellisoftgroup.com.

TIP 1 Respond to information requests within 30 days; otherwise, the MAC may reject your enrollment.

TIP 2 Your MAC won’t process your PECOS enrollment application without your electronic signature and necessary supporting documentation. The effective application enrollment date is the date the MAC gets your electronic signature.

Missing Documents IRS documents, CMS 588 EFT, voided check, band letter, education documentation, par agreement, cert term page, org charts

Missing Fields (missing signature/date)

Wrong Signature (paper)

Incorrect Information

Missing Application Fee

30-35%delayed

need at least one round of

corrections

Common Pitfalls