Medicare physicians who have not updated their enrollment information in the past five years may need to fill out another application or face payment problems for ordered or referred services. The new rules, which take effect April 5, authorize Medicare to reject claims if an ordering physician is not identified in Medicare's PECOS enrollment system.
If you are not sure if you are already in the PECOS system, the Centers for Medicare & Medicaid Services has posted a list of all physicians enrolled in PECOS on its website. Be aware that this is an enormous document, containing over 13,000 pages, and as such it will take time to download. To see if you are on the list, go to the search tool and enter your type 1 (individual) NPI number, or last name, and hit enter. If you do not appear on this list, you will need to revalidate your enrollment with Medicare. This list will be updated periodically so applications currently being processed can be added to the list.
If you determine that you do need to submit a new enrollment form, you can do so online using the web-based PECOS system or by filling out the appropriate paper enrollment form(s) (CMS-855I and CMS-855R, if appropriate) and mailing the forms, along with any required additional supplemental documentation to Palmetto, who will enter your information into PECOS and process your enrollment application. If you enroll online, be sure to also mail to Palmetto the signed and dated Certification Statement within seven days.
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