PECOS: Provider Enrollment Chain and Ownership System

PECOS and Medicare Order and Refer Enrollment 

What is PECOS? What does Order and Refer mean?

PECOS stands for the “Provider Enrollment Chain and Ownership System.”  “Ordering/Referring provider” denotes an individual who orders refers, or certifies an item or service reported in a claim.  PECOS enrollment is not specific to one hospital, and is transferable.  See additional background information under Why do all residents/fellows need to be enrolled in Medicare to Order and Refer? (PECOS), below.

The UMN GME Office requires that all residents/fellows be enrolled in PECOS.

Resource:

PECOS Enrollment Process

  1. Conduct a search to determine if each resident/fellow in your program is already enrolled in PECOS (as orderer/referer, provider, or biller)

    1. Search PECOS Validation database *Non-CMS site to conveniently search PECOS enrollments
      - OR -
    2. Search the CMS PECOS database. *Note: the CMS search site is only updated 1x/month
  1. Assist residents/fellows in enrolling in Medicare to Order and Refer (PECOS) via one of two methods:
    A paper application (CMS 8550) which programs are strongly encouraged to assist residents/fellows to complete, or an individual online enrollment, which residents/fellows complete individually on their own.  Do not submit an Order and Refer application if the resident/fellow is already enrolled! (See step one, above)

    1. Paper Application:
      1. UMN Instructions on Enrolling and Updating PECOS Order and Refer (Paper and Online)
        1. Check Application Status of submitted PECOS application
        2. CMS Application Enrollment Checklist
      2. UMN Guide -  Paper Application CMS 8550
      3. Blank Paper Application Template - CMS 8550

        - OR -

    2. Online Application
      1. CMS Individual Resident/Fellow Online Enrollment Registration/Log In
      2. CMS Individual Resident/Fellow Online Enrollment Instructions
      3. CMS Individual Resident/Fellow Online Enrollment Video Tutorial
  1. Report PECOS enrollment to GME/affiliated hospitals & sites

    1. *Reporting of PECOS status in RMS is required for all residents/fellows
      1. See UMN Instructions - Report Resident/Fellow PECOS Enrollment in RMS

Why do all residents/fellows need to be enrolled in Medicare to Order and Refer? (PECOS)

Enrollment in PECOS (CMS 8550) via the Centers for Medicare and Medicaid Services (CMS) allows residents/fellows who do not already hold a biller/provider enrollment with CMS, to enroll and be eligible to order, certify, and/or prescribe Part D drugs, without having to list a separate authorized provider, and complete workarounds to ensure prescriptions go through the hospital and pharmacy without error. Enrollment of residents/fellows in PECOS will result in workflow improvements, have a positive impact on the patient experience when being discharged (CLER focus area), as well as reducing the work of the attending, thus allowing more time to focus on patient care. PECOS enrollment is managed by each individual program or department.

Nationally, CMS is requiring all residents/fellows (Part D prescribers) to be enrolled in PECOS (Order and Refer) by January 1, 2019. The UMN GME Office is requiring that all incoming residents/fellows be enrolled in PECOS to ensure compliance with the expectation that all continuing/advancing/changing program residents/fellows have already been enrolled in PECOS.

Resources:

Helpful links/contact information:

Contact CMS for PECOS technical assistance:

MAC (Medicare Appointed Contractor) contact: 

Contact MAC for any application processing related questions.

National Government Services, Inc.
Phone: 877-908-8476
Address: National Government Services, Inc. Provider Enrollment
P.O. Box 6475
Indianapolis, IN 46206-6475