The original deadline set by CMS for all ordering and referring providers to enroll in the Provider Enrollment Chain and Ownership System (PECOS) was set for July 6, 2010.  However, in a news release dated June 30th, CMS announced that they will not make the changes that will automatically reject claims based on ordering or referring providers who have not yet enrolled in the PECOS system.

If you have enrolled in the Medicare program or made changes/updates within the past 6 years, you are most likely already enrolled in the PECOS system.  However, if you have not enrolled in the Medicare program or made any changes/update with the last 6 years, you will need to complete the enrollment process.  By using your NPI, login username and password, you can access the PECOS site.

CMS has been encouraging providers to use the PECOS system to enroll in Medicare or submit any updates or changes to their Medicare information for quite a while. Now they are mandating the use of PECOS by denying any claims for services that were ordered or referred by a Medicare provider who is not enrolled in the PECOS system. This makes things tough because the provider submitting the claim cannot control if the ordering or referring provider has enrolled in PECOS. This may be why they announced that they would not make the changes that would result in the denial of claims that were ordered or referred by providers not enrolled in PECOS.

At some point, this mandate probably will be implemented so it really is in a provider’s best interest to make sure they are compliant. If you do not know if you or your provider is enrolled in PECOS then you should check. There is a national list available online.  The names of NPI numbers of all providers in the U.S. who are enrolled in the PECOS system can be found on that list. You can check that list to see if you or your provider is enrolled. You can also call the local Medicare carrier provider enrollment line and ask if you or your provider is already enrolled.

If you or your provider is not enrolled you will either need to enroll by completing the application online thru the PECOS website, or by submitting a paper enrollment application re-validating the information, even if nothing has changed. I would suggest that you do not wait until your claims start to be denied.