PECOS
PECOS is Medicare's provider enrollment system — where a provider's Medicare enrollment record lives, is updated, and is revalidated.
Updated
PECOS — the Provider Enrollment, Chain, and Ownership System — is the system CMS uses to hold Medicare provider enrollment records. It is where an enrollment application is submitted, where the resulting record lives, and where changes and revalidations are processed.
Enrollment applications are made on the CMS-855 family of forms, which differ by who is enrolling and for what purpose — an individual practitioner, a group or supplier organization, an institutional provider, and others. The family is not fixed: CMS consolidated the separate reassignment form into the individual application in 2023, so the current set is whatever CMS publishes. PECOS is the electronic path for those applications.
In practice
The record in PECOS is what Medicare checks a claim against, which makes it the single source of truth for whether a Medicare claim will pay on the provider question. If the record says something different from the claim — a different practice location, a reassignment that was never filed — the claim is refused, and the fix is in the record rather than in the claim.
Enrollment is not permanent. CMS requires providers to revalidate their enrollment on a published cycle, and a record that goes stale can be deactivated. Because the revalidation cycle and its notice period are set by CMS and change, the applicable timing is whatever CMS currently publishes for that provider type.
Commonly confused with
- NPPES: NPPES issues and holds the NPI — the identifier. PECOS holds the Medicare enrollment record — the relationship. Having an NPI does not enroll anyone in Medicare.
- CAQH: CAQH is the shared data source many commercial payers credential from. Medicare uses PECOS, and does not credential from CAQH.