What is PECOS (Provider Enrollment, Chain and Ownership System)?

PECOS (Provider Enrollment, Chain and Ownership System) Definition

PECOS (Provider Enrollment, Chain and Ownership System) is the "Gatekeeper for Medicare." For Provider Ops and Health System Leaders, PECOS is the digital system of record for federal reimbursement. A provider must be "Active" in PECOS to bill Medicare. Operationally, PECOS is notorious for its complexity; it requires detailed disclosures about "Ownership and Control"—who owns the medical group and whether they have any past legal issues. For Payers, the PECOS database is a "Primary Source" for verifying a provider’s Medicare status. Strategically, managing PECOS data is a critical part of the revenue cycle; if a provider’s PECOS record expires or is deactivated, every Medicare claim they submit will be rejected instantly.

FAQs

How does PECOS relate to the NPI?

You must have an NPI before you can apply for enrollment in PECOS. PECOS uses the NPI as the unique identifier for the provider’s Medicare profile.

What is a "Medicare Revalidation"?

CMS requires providers to "revalidate" their PECOS info every 5 years (3 years for DME providers) to ensure all data, especially ownership, is current.

Can a provider use a paper application instead of PECOS?

Yes (using the CMS-855 forms), but CMS strongly prefers PECOS because it is faster and has automated validation checks that reduce errors.