Locked-out accounts
Providers create an I&A account years ago, lose the credentials, and cannot reset them without identity verification through CMS. Applications stall before they start.
Provider credentialing
PECOS Enrollment and Account Management
PECOS is the system Medicare uses to receive, process and store every enrollment record. We create and manage your PECOS account, keep it accurate, and use it to file every Medicare application so nothing goes to paper.
PECOS at a glance
- Run by CMS for Medicare enrollment
- Requires an I&A account and NPI
- Surrogate access lets us file for you
- Changes reportable within 30 days
- Source of the ordering and referring file
- Surrogate access
- managed under your I&A account
- Same-day
- record corrections when a MAC flags a mismatch
- Zero paper
- every Medicare application filed electronically
The application path we run for this payer
- 1
Intake and gap review
Licenses, DEA, board certificates, malpractice, work history and NPI details are collected and compared against what each target payer asks for.
- 2
Profile setup
CAQH ProView, PECOS and payer portals are created or cleaned up, attested and linked to the correct Tax ID and locations.
- 3
Application submission
Every enrollment is filed in dependency order, with a tracking record for each payer, date and reference number.
- 4
Follow-up on a fixed cadence
Payers are contacted on a schedule. Requests for more information are answered the same business day.
- 5
Approval, contract and handoff
Effective dates, provider IDs and fee schedules are logged and loaded into your billing system.
The Provider Enrollment, Chain and Ownership System, PECOS, is how CMS tracks who is allowed to bill Medicare, order services and refer patients. A provider who is not in PECOS cannot be paid, and a provider whose PECOS record is out of date will see claims deny for ordering and referring edits that seem to come from nowhere.
ClainetRCM sets up your Identity and Access Management account, establishes surrogate access so we can work on your behalf, and keeps your PECOS record aligned with NPPES, your state license and your practice locations.
Where this usually goes wrong
Records that disagree
When PECOS, NPPES and the state license show different names, addresses or taxonomies, the MAC returns the application for development.
Ordering and referring denials
If a provider is not in PECOS with an approved record, claims from labs, DME suppliers and home health agencies that list them as the ordering provider will deny.
What ClainetRCM handles
One coordinator owns the file from intake to effective date.
- I&A account creation, recovery and identity verification
- Surrogate and staff end user setup under the correct roles
- New enrollment, change of information and reassignment filings in PECOS
- NPPES and PECOS data alignment before submission
- Ordering and referring eligibility confirmation
- Ongoing PECOS record maintenance as locations, ownership or names change
What PECOS is used for, beyond the first application
| Initial enrollment | Filing CMS-855I, 855B and 855R electronically, with e-signature and application fee payment. |
|---|---|
| Changes of information | New practice locations, name changes, ownership changes and reassignment updates must be reported within 30 days in most cases. |
| Revalidation | Cycle revalidation is completed in PECOS; see Medicare revalidation. |
| Ordering and referring | PECOS is the source of the file that other suppliers' claims are edited against. |
| Opt-out and withdrawal | Voluntary termination or opt-out affidavits when a provider leaves Medicare. |
PECOS depends on a valid NPI and, for groups, an approved entity. We handle both under healthcare business registrations.
Questions about PECOS Enrollment
PECOS is the online system; Medicare enrollment is the process. You can technically enroll on paper, but paper applications take longer and are more often returned. We file everything through PECOS. Our Medicare provider enrollment page covers the applications themselves.
Yes, through surrogate access under your I&A account. You approve the connection, we work within the roles you grant, and you can revoke access at any time. We never ask for your personal login.
If you order or refer Medicare-covered services, such as lab tests, imaging, DME or home health, the billing supplier's claim is checked against PECOS. Providers who are not enrolled can file an ordering and referring only application so those claims pay.
Any time a reportable change happens: new location, ownership change, name change, or a provider joining or leaving the group. Most changes must be reported within 30 days, and some within 90. We update the record as part of ongoing maintenance.
Other payers and enrollment pages
Back to the provider credentialing overview, or continue with a related page.
Medicare Provider Enrollment Services
CMS-855 applications and PECOS filing
Medicaid Provider Enrollment Services
State Medicaid and MCO enrollment
Medicare Revalidation Services
Cycle revalidation without deactivation
Insurance Credentialing Services
Commercial and government panels, end to end
Healthcare business registrations
NPI, EIN and entity setup that PECOS depends on
Home health and hospice
Ordering and referring edits hit this setting hardest
Diagnostic laboratories
Claims edited against the PECOS ordering file
Free revenue audit
Find out what your practice is losing to denials.
Send us 90 days of remittance data and we will show you, line by line, which claims were underpaid, denied, or never worked, and what it would take to recover them. No cost, no obligation, and you keep the report either way.
No setup fee. No long-term contract. Pricing from 2.29% of monthly collections.