What this checks
PECOS is the Medicare enrollment system. CMS publishes two lists from it that matter when you take an order or a referral:
- Medicare fee-for-service enrollment: every provider with an approved Medicare enrollment, and as what (for example Practitioner - Internal Medicine).
- Order and referring: providers who may order or refer for Part B services, durable medical equipment (DME), home health (HHA), power mobility devices (PMD) and hospice. If the ordering doctor is not on this list for the service, Medicare denies the claim.
We also show the Medicare opt-out list: a provider who opted out cannot bill Medicare, and their orders for Medicare patients are only payable in limited cases.
Who needs a PECOS check
DME and orthotics suppliers, labs, imaging centers, home health agencies and hospices check the ordering or referring provider before they deliver, because a missing PECOS enrollment is one of the most common reasons for denied claims. Billing companies run the same check on a whole client roster.
Checking a list
The bulk lookup runs the PECOS check together with NPI status and the OIG exclusion list on every NPI in a spreadsheet. 100 free a day with a free account, then from $5 for 5,000. Developers can use the NPI API.
Where the data comes from
The CMS Medicare Fee-For-Service Public Provider Enrollment file and the CMS Order and Referring file, both from data.cms.gov, and the CMS opt-out affidavit list. We reload them every month. For a decision that matters, confirm in PECOS itself.