Credentialing is an in-depth review process to verify a healthcare provider’s qualifications to ensure they can provide care or services to patients. The process includes obtaining and assessing documented evidence of a provider’s licensure, education, training, career history, and other qualifications from a primary source (such as a medical school). It also includes submitting applications for data and other processes, like malpractice claims review.

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Why is PECOS Required for Medicare Enrollment?

There are two ways to enroll in the Medicare program. First, complete the appropriate Medicare paper applications, or second, use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). PECOS supports the Medicare provider and supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information.

PECOS stands for Provider, Enrollment, Chain, and Ownership System. 

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PECOS Pre-Enrollment Checklist

Before you begin registration in the PECOS, make sure you have all of the information CMS requires. The checklist below details all of the information and documents you will need to complete enrollment successfully:

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• National Provider Identifier (NPI)

• National Plan and Provider Enumeration System (NPPES) ID & Password

• Personal Identifying Information i.e., Legal name, Date of birth, and Social Security number

• Schooling Information like School name, and Graduation year

• Professional License Information i.e., Medical license number, Original effective date, Renewal date, and State issued

• Certification Information i.e., Certification number, Original effective date, Renewal date, and State issued

• Specialty/Secondary Specialty Information

• Drug Enforcement Agency (DEA) Number

• Electronic Funds Transfer Authorization Agreement CMS-588

• Information About Final Adverse Actions (if applicable)

•  Practice Location Information

•  Medical practice location

•  Special payment information

•  Medical record storage information

•  Billing agency information (if applicable)

•  Any federal, state, and/or local professional licenses, certifications and/or registrations required for practice

PECOS Enrollment

After you log in to the PECOS system, you will be guided through a series of steps to select the appropriate application and enter your information. Similar to selecting the appropriate paper application, it is important to select the proper enrollment type within the PECOS system so that you transfer the appropriate information to Medicare for your enrollment record.

After submitting your application via PECOS, you can check the status of your application online directly with the MAC through their website or via the PECOS application status check page. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Ordering-and-Certifying

Suggested Links:

For enrollment:  https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/index

If you don’t know your NPI: https://nppes.cms.hhs.gov/