Provider Enrollment, Chain and Ownership System (PECOS)

Key facts

Operated by

Centers for Medicare & Medicaid Services (CMS)

Regulations

42 CFR Part 424, Subpart P (Medicare enrollment)

Paper equivalents

CMS-855 forms, such as 855I, 855B, 855A, 855O and 855S

Revalidation

Every 5 years; every 3 years for DMEPOS suppliers

What is PECOS?

Enrolling in Medicare gives a provider billing privileges, and PECOS holds that enrollment record: identity, NPI, practice locations, Medicare specialty, reassignment of payments to groups, and the owners and managing employees of organizations. CMS and its Medicare Administrative Contractors review applications and screen enrollees against licensure and exclusion data.

An NPI from NPPES is required to enroll, but the two systems are separate. NPPES assigns identifiers to almost any provider, while PECOS covers only providers enrolled in Medicare, including practitioners who enroll only to order and refer.

How Medicare enrollment works

Enrollment follows the type of provider:

• Individual practitioners enroll using form CMS-855I or its online equivalent in PECOS.
• Clinics, group practices and certain suppliers use CMS-855B; hospitals and other institutional providers use CMS-855A.
• Practitioners who work for a group reassign their right to Medicare payment to that group.
• Practitioners who only order and refer use CMS-855O, and suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) use CMS-855S.
• Enrolled providers revalidate on a fixed cycle and must report certain changes within set deadlines.

Why PECOS matters

PECOS feeds several public CMS datasets, including provider enrollment files, the ordering and referring file, reassignment data and ownership files for facilities. It records each provider's Medicare specialty, links individual clinicians to the groups that bill for them and lists owners of organizations. Those links support affiliation mapping, analysis of practice consolidation and private equity ownership, and fraud screening. The PECOS Associate Control (PAC) ID in these files also appears in CMS Doctors and Clinicians data.

Limitations of PECOS data

PECOS reflects Medicare enrollment only. Clinicians who do not bill Medicare, or who have opted out, are missing or incomplete, and enrollment addresses reflect where Medicare services are billed rather than every place a clinician works.