PECOS: What Urgent Cares Need to Know

The Provider Enrollment, Chain, and Ownership System (PECOS) is nothing new in the Medicare world. But, we get a lot of questions about it. We’re here to help.

What is PECOS?

PECOS is an online Medicare enrollment system for healthcare providers. It is an alternative to submitting a paper application. Providers are also able to make changes to enrollment information or voluntarily withdraw from Medicare. While the paper enrollment application is always valid, PECOS is faster to complete and easier to process.

What are the advantages to enrolling through PECOS?

• Faster than paper – 45- vs. 60-day processing
• Tailored – Supply only information relevant to your application
• Simple – Easy to check and update

Urgent care providers are not required to accept Medicare patients or insurance, but most urgent care clinics do have at least one provider that treats Medicare-covered patients.

How does PECOS affect you?

Submitting accurate Medicare enrollment applications is a crucial piece that affects your reimbursement. Once an enrollment record has been created, it is vital that all information is kept up to date. One of the largest issues we see facing our clients today is the need to update PECOS after a facility is added with a new IRS-issued Taxpayer Identification Number (TIN). If your information isn’t up to date, you might not be properly reimbursed.

What do you need to get started with PECOS?

The same information needed for a paper Medicare enrollment application will be needed for your PECOS enrollment application. In addition, make sure to complete the following prior to beginning the application process:

• If you haven’t done so already, create a username and password with the Identity & Access Management (I&A) System.
• Once credentials have been created in the I&A System, use the same username and password to log in to the National Plan and Provider Enumeration System (NPPES) to register for a National Provider Identifier (NPI). Medicare enrollees must have an active NPI.

For a complete listing of all necessary information to complete the PECOS enrollment process—and several other FAQs regarding PECOS—read the FAQ document provided by CMS.