Healthcare credentialing is the process to verify provider education, training, and proven skills before a practitioner, provider, or facility can receive payment from Medicare, Medicaid, or private payors.

Because Medicare in particular is such an important payor for so many ambulatory practices, providers and practice staff want to simplify and shorten the process to become a registered Medicare provider or facility. The Provider Enrollment, Chain, and Ownership System (PECOS) database is the fastest and most accurate way to accomplish this, whether adding new physicians to an existing practice or starting a new one. 

It’s fast(er)

In addition to eliminating costs associated with paper and postage, the move away from “snail mail” to online processing of Medicare provider application significantly speeds the enrollment process, which in turn improves cash flow. Individual Medicare provider enrollment may take approximately two months to process through the PECOS system; longer to validate credentials and issue Medicare facility status.

When regular mail and phone follow up was the only way to complete credentialing, the time required to complete an application quickly grew if anything was missing from an application or additional documentation was needed. Including when Medicare sends notification of a full and properly executed application. Which happens before an application begins the processing phase of credentialing prior to approval as a Medicare provider or facility. All done with email using PECOS.

PECOS offers a real-time view of provider enrollment status. Without PECOS, this information could only be retrieved by calling Medicare and speaking with them directly. If the person inquiring about a provider’s enrollment status is not listed on the provider’s profile, Medicare will not give any status on the pending enrollment. With access to PECOS, anyone listed as a contact on the provider’s individual record can easily pull enrollment status details.

It’s easy and secure

The PECOS system uses a provider’s national provider identification (NPI) for secure login. Many practices outsource ongoing credentialing and the outsourcing partner gains access to the PECOS system on behalf of their client in a similar manner. For organizations who partner with an outsourced provider enrollment company, the burden of completing Medicare enrollments can be further alleviated when allowing the enrollment partner to act on the provider’s behalf through Surrogacy Access. This allows designated staff at the enrollment partner company to log into a provider’s portal to complete and manage the provider’s Medicare enrollment. For larger organizations with hundreds of providers, outsourcing Medicare enrollment can save significant time and money. With access to PECOS, the partner company can efficiently manage the entire initial and re-validation process.

Clarifying PECOS Confusion

One common PECOS misconception is the belief that an online PECOS application also requires a duplicate hard copy mailed to Medicare. This is not true. Once submitted online, there are no additional steps required as long as the online application is complete and accurate. If Medicare has a question or request, as I stated above, the submitter will be alerted via email.

Another point of confusion: How long you have to supply authorized signatures for electronic sign-off – either for new applications or to reassign a provider’s or facility’s right to bill the Medicare program. Previously it was three days; now organizations have 14 days to submit authorized signatures.

When working with a provider enrollment company, privacy concerns over sharing a provider’s user name and password have some organizations opting out of PECOS. For those who want tighter control, PECOS offers the option of logging in and authorizing someone to work on the provider’s behalf. The authorized person then creates his/her own user name and password.

What’s the bottom line?

Provider enrollment professionals know what they are doing and will work to make sure the provider gets paid appropriately. Enabling them to access PECOS will allow them to do their job more efficiently and to get your providers billing faster than if processed manually using paper and regular mail.

For More Information:

  1. Download our eBook Seven Tips to Succeed in the Evolving Credentialing Landscape
  2. Read Seven Secrets to Getting Paid, part of our RCM Optimization Kit.
  3. Contact us to learn about our credentialing services.