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Prevent Claims Rejections for Referred Services: Update PECOS Enrollment Records

    • The Centers for Medicare & Medicaid Services (CMS) published in the May 5, 2010 Federal Register, its mandate that all ordering/referring providers of services for Medicare beneficiaries have current enrollment records in the Provider Enrollment Chain and Ownership System (PECOS).

      Based on earlier directives of CMS, Medicare carriers will likely adopt a PECOS implementation deadline in the near future, after which Medicare claims may be rejected for certain services that were ordered or referred by physicians or non-physician practitioners who do not have current enrollment records in internet-based PECOS.

      These same practitioners also risk enrollment deactivation and temporary suspension of Medicare billing privileges until their enrollment records are updated with the local Medicare Part B carrier. Even if a practitioner has been enrolled in Medicare for years, the practitioner still needs to verify that he/she has an active and accurate PECOS enrollment record.

      PECOS background

      In late 2008, CMS announced that it would begin offering an internet-based provider enrollment system for new and existing practitioners needing to make certain changes to enrollment records. PECOS is a database of standardized enrollment information accessed by Medicare and its affiliated carriers for claims payment purposes. Each enrollment record contains information not limited to the practitioner's name and address, provider type and specialty, affiliated practices and/or facilities, collaborative agreements, state license number, board certification status, and prior legal actions.

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