CMS Processes Claims Despite PECOS Enrollment Status

Providers that did not get their Provider Enrollment, Chain and Ownership System (PECOS) enrollment applications approved by the July 6 deadline are getting a temporary reprieve. The Centers for Medicare & Medicaid Services (CMS) says it will not, for the time being, implement automatic rejections of claims submitted by providers that are not enrolled in PECOS. Until the automatic rejections are operational, submitted claims will continue to be reviewed and paid as usual.

While more than 800,000 physicians and other health professionals have enrolled and received approved applications in the PECOS system, the Centers for Medicare & Medicaid Services (CMS) says some providers have encountered problems.

CMS issued an interim final regulation May 5, implementing provisions of the Affordable Care Act that permit only a Medicare enrolled physician or eligible professional to certify or order home health services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and certain items and services under Medicare Part B. The new law applies to orders, referrals, and certifications made on or after July 1. The comment period for the regulation closed on July 6.

The agency says it will employ a contingency plan to meet the Affordable Care Act requirement that written orders and certifications are only issued by PECOS enrolled eligible professionals effective July 1, but did not go into detail.

Meanwhile, CMS says it will continue to send informational notices to providers reminding them of the need to submit or update their enrollment and will process all applications expeditiously.

Source: CMS media release issued June 30

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2 Responses to “CMS Processes Claims Despite PECOS Enrollment Status”

  1. GENOVA says:

    Do providers that are asked to see pts at nursing home have to sign up with PECOS.

  2. Shanna says:

    Do ambulance providers have to sign up with pecos?

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