Medicare Ordering/Referring Physician Files (PECOS)
Medicare has not yet implemented the automatic denial for claims submitted with an ordering or referring physician who does not have a current PECOS record. CMS is working to clean up system problems and backlogs prior to implementing this rule. When the rule is in effect, any claim that includes an ordering or referring provider who is not eligible or who is not in the PECOS system will be automatically denied. It is important for providers to be aware of their Medicare enrollment records and to know if they have a current PECOS record. It will also be important to know that your referring or ordering physician have a PECOS record.
How do I know if a provider has a PECOS record?
You can download the Medicare Ordering and Referring File on the CMS website by clicking here. The link will provide you with additional information about the ordering/referring rule, and will allow you to download the file in .pdf or .csv format for searching.
How do I get my Medicare Provider Enrollment Record in PECOS?
If you have submitted a CMS855I after April 2011, your record will be in the PECOS system. If you enrolled prior to then, you’ll need to go through the re-validation process if you have not already done so. Medicare revalidation can be accomplished by submitting a CMS855I or entering your enrollment records directly through PECOS using your NPI login information. When submitting a paper enrollment application, your enrollment record is entered into PECOS by the Medicare contractor receiving your application.
I’m Busy, how can I get help with my Medicare Provider Enrollment record in PECOS?
nCred can help you with all your payor enrollment needs including Medicare. We’ll submit your enrollment application to the appropriate Medicare contractor and follow up to make sure your application is process timely. Fill out the information form below and someone will get in touch with you to discuss your options.
