Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS)

MLM Article: SE0914 This article is for physicians, non-physician practitioners, and organization providers and suppliers who are enrolled or wish to enroll in the Medicare program. NOTE: Suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) do not, at this time, have the option of using Internet-based PECOS. The availability of Internet-based PECOS to DMEPOS suppliers will be announced at a future date. http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0914.pdf Provider Action Needed This Special Edition (SE) 0914 article alerts physicians, non-physician practitioners, providers and suppliers that the Centers for Medicare & Medicaid Services (CMS) is reaching out to assist those providers and suppliers who wish to use Internet-based PECOS for enrollment in Medicare and/or to maintain the currency of the enrollment data they have on file with Medicare. Internet-based PECOS offers physicians, non-physician practitioners, and organization providers and suppliers a means of applying for enrollment and updating their enrollment information faster than the paper enrollment process that required the use of the paper CMS-855 series of forms. The documents that describe Internet-based PECOS are available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.a... on the CMS website. Background Internet-based PECOS has been available to physicians and non-physician practitioners since December 2008, and to organization providers and suppliers since April 1, 2009. (As noted above, DMEPOS suppliers may not use the system at this time, but will be able to do so at a future date.) There are certain pre-requisites that must be met before one can use Internet-based PECOS. In addition, the processes for physicians and non-physician practitioners differ somewhat from those used by provider and supplier organizations. This article will present a high-level overview of these processes and will direct physicians, non-physician practitioners, providers, and organization providers and suppliers to other sources available via the Medicare Learning Network (MLN) that will enable them to learn more. An important benefit for all physicians, non-physician practitioners, and organization providers and suppliers is that Internet-based PECOS speeds up the completion of their initial Medicare enrollment application as well as the update of their enrollment information when changes occur. CMS timelines for Medicare contractors to process Internet-submitted enrollment applications are more stringent than those for paper: • Contractors must process 90 percent of web-based applications (e.g., initial enrollments and changes of information) within 45 days of receipt of the signed and dated Certification Statement and supporting documentation. • Contractors must process 80 percent of initial paper applications within 60 days, and 80 percent of paper changes of information within 45 days. With the temporary exception of the DMEPOS suppliers, physicians, non-physician practitioners, and organization providers and suppliers can use the Internet to enroll in Medicare, to update their existing enrollment information, to view their existing enrollment information, or to voluntarily terminate their Medicare enrollment. Once a provider or supplier submits an application via the web, the provider or supplier can view the status of that application beginning 15 days after the submission. (The 15-day time frame allows sufficient time for the Medicare enrollment contractor to have received the signed and dated Certification Statement and begin action on the application. More information about the Certification Statement will be supplied later in this article.) One crucial point that physicians, non-physician practitioners, and organization providers and suppliers should understand is that, if they want information, or to terminate their enrollment in Medicare, they must first have an enrollment record in PECOS. If a physician, non-physician practitioner, or organization provider or supplier enrolled in Medicare more than 5 years ago and has not submitted any updates or changes to their enrollment record over the past 5 years, it is very likely that the provider or supplier is not in PECOS. If one of these providers or suppliers accesses Internet-based PECOS attempts to view or update the enrollment record, there will be nothing there to view or update. Providers and suppliers who find themselves in this situation will have to revalidate their enrollment with Medicare. In order to revalidate, the provider or supplier has to furnish all the information necessary to initially enroll in Medicare. This will get the provider or supplier into PECOS and will ensure that their enrollment information, which may have changed over the years, is current. If they never submitted the CMS-588 Electronic Funds Transfer Agreement, they will have to do so as part of the revalidation. Providers and suppliers can revalidate their enrollment via Internet-based PECOS or they can fill out the appropriate paper CMS-855 Medicare provider enrollment forms and mail them to the appropriate enrollment contractor. The remainder of this article provides the overviews of the processes for using Internet-based PECOS and identifies other sources of information. Physicians and Non-Physician Practitioners Before a physician or non-physician practitioner initiates a Medicare enrollment action using Internet-based PECOS, he or she will need the following: • An active National Provider Identifier (NPI); • A National Plan and Provider Enumeration System (NPPES) User ID and password; • Personal identifying information, which includes the physician’s or non-physician practitioner’s legal name on file with the Social Security Administration, date of birth, and Social Security Number; • Professional license and certification information, which includes information regarding the physician’s or non-physician practitioner’s professional license, professional school degrees or certificates; • Practice location information, which includes information regarding the physician’s or non-physician practitioner’s medical practice location; • The legal business name of a solely-owned Professional Association (PA), Professional Corporation (PC), or Limited Liability Company (LLC) on file with the Internal Revenue Service and appearing on the IRS CP575 form; A photocopy of the CP-575 form; • The NPI of the PA, PC, or LLC; and • Any Federal, State, and/or local (city/county) business licenses, certifications and/or registrations specifically required by that business to operate as a health care facility; and • If applicable, information about any final adverse action that impacts the physician or non-physician practitioner. Internet based PECOS can be accessed with the same User ID and password that a physician or non-physician practitioner uses for NPPES. If the physician or non-physician practitioner does not have an NPPES User ID and password and needs help in obtaining one, he or she may contact the NPI Enumerator at 1-800-465-3203 or send an email to customerservice@npienumerator.com on the Internet. Note: CMS recommends that a physician or non-physician practitioner change his/her NPPES password before accessing Internet based PECOS for the first time and at least once a year thereafter. Although the User ID cannot be changed, the password should be changed periodically – at least once a year. If you need help in changing your password, contact the NPI Enumerator at 1-800-465-3203 or send an email to customerservice@npienumerator.com on the Internet For physicians and non-physician practitioners, there are three basic steps to completing an enrollment action using Internet-based PECOS. • Use your National Plan and Provider Enumeration System (NPPES) User ID and password to log on to Internet-based PECOS at https://pecos.cms.hhs.gov/pecos/login.do ; • Complete, review, and submit the electronic enrollment application via Internet-based PECOS; • Print, sign and date the Certification Statement and mail the Certification Statement and all supporting paper documentation to the designated Medicare contractor within 7 days of electronic submission. Note: A Medicare contractor will not process an Internet enrollment application without receipt of the signed and dated Certification Statement. In addition, the effective date of filing an enrollment application is the date the Medicare contractor receives the signed Certification Statement that is associated with the Internet-submitted application. The Certification Statement must be signed by the physician or non-physician practitioner enrolling or making changes to enrollment information. Signatures must be original and in ink (blue ink recommended). Copied or stamped signatures or dates will not be accepted. The physician or non-physician practitioner assumes full and complete liability for new and updated Medicare enrollment information that is transmitted to the enrollment contractor via Internet-based PECOS once the enrollment contractor receives the signed and dated Certification Statement. While CMS encourages physicians and non-physician practitioners to print and retain a copy of the Internet-submitted enrollment application for their records, physicians and non-physician practitioners should only mail the Certification Statement and supporting documentation to the designated Medicare contractor. Do not mail the copy of the enrollment application to the designated Medicare contractor; to do so may delay the processing of the application. For more information about Internet-based PECOS, along with questions and answers (Q&As), go to the Downloads section at http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.a... on the CMS website. Provider and Supplier Organizations Before a provider or supplier organization can use Internet based PECOS, the organization’s Authorized Official must take the first step. Below is the process that occurs for an organization provider or supplier to gain access to Internet-based PECOS: 1. The organization provider/supplier’s Authorized Official (AO) goes into PECOS I&A and registers. As part of this process, the AO must mail a photocopy of the CP-575 to the CMS EUS Help Desk so that the Help Desk can verify the organization provider/supplier. 2. The Help Desk verifies both the organization provider/supplier and the AO, and approves the AO’s registration. The AO receives a system-generated e-mail indicating that the registration has been approved. 3. Once the AO receives this notification, the AO can let the end-user know that he/she can register in PECOS. 4. The end-user goes into PECOS I&A and registers. The registration request will be directed to the AO of the provider/supplier organization. 5. The AO must approve or reject the end-user in PECOS I&A. 6. Once the end-user has been approved in PECOS I&A by the AO for access on behalf of the organization provider/supplier, the end-user will receive a system-generated e-mail indicating that he/she has been approved. 7. The end-user then logs into PECOS and downloads the Security Consent Form. He or she fills it out, obtains the signature/date of signature of the AO, and mails the completed Security Consent Form to the CMS EUS Help Desk at P.O. Box 792750, San Antonio, TX 78216. The Help Desk verifies the information on the Security Consent Form and also calls the AO to verify that the AO did, in fact, sign the Security Consent Form. 9. Once the information on the security Consent Form has been confirmed, the Help Desk approves the Security Consent Form in PECOS and an e-mail is sent to the AO notifying the AO that the end user’s organization has been approved to use Internet-based PECOS on behalf of the organization provider/supplier. 10. It is the AO’s responsibility to notify the end-user’s organization that the end-user can now use Internet-based PECOS. An e-mail is sent to the AO (step 9) because the AO is ultimately responsible for the enrollment information and who has access to that enrollment information. It is the AO’s responsibility to inform the end-user that the Security Consent Form has been approved. Note: The Security Consent Form is completed only one time to establish the relationship between the provider or supplier organization and the employer organization whose employee( would submit enrollment applications on behalf of the provider or supplier organization. More than one individual may request access to Internet-based PECOS for a given provider or supplier organization, but the Security Consent Form is generated and completed by the first (if more than one) approved user who logs on to Internet-based PECOS to submit an enrollment application for the given provider or supplier organization. A Security Consent Form must be completed, signed and dated, and mailed to the CMS EUS Help Desk even if the employer organization is the provider or supplier organization. More detail about obtaining access to Internet-based PECOS for providers and suppliers can be found in the document entitled, “Getting Started with Internet-based Provider Enrollment, Chain and Ownership System (PECOS) – Information for Provider and Supplier Organizations,” along with Q&As is available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrganizationG... on the CMS web site. Limitations of Internet-based PECOS for Provider and Supplier Organizations There are some scenarios that Internet-based PECOS cannot accommodate at this time; they will be available at a future date. These scenarios are: • Changes in Taxpayer Identification Number (TIN). These must be done using the paper enrollment application (CMS-855). • Changes in Legal Business Name (LBN). These must be done using the paper enrollment application (CMS-855). • An enrolled Medicare Part A provider or supplier organization wants to enroll with a Medicare carrier or A/B Medicare Administrative Contractor (MAC) to bill for Part B services. This must be done using the paper enrollment application (CMS-855). These scenarios are listed in the document entitled, “Overview of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) – Information for Provider and Supplier Organizations,” available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrganizationO... on the CMS website. Additional Information The CMS External User Services (EUS) Help Desk contact information for providers and suppliers using Internet-based PECOS can be found at http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/ContactInform... on the CMS website. The Help Desk hours of operation are Monday – Friday, from 6 a.m. to 6 p.m. Central Standard Time. The Help Desk toll-free number is 1-866-484-8049 and their e-mail address is eussupport@cgi.com. Questions about accessing and using Internet-based PECOS should be directed to the CMS EUS Help Desk. The overall CMS site regarding provider and supplier enrollment can be found at http://www.cms.hhs.gov/MedicareProviderSupEnroll on the CMS website. From there, click on “Internet-based PECOS” on the left-hand side to go to information specific to Internet-based PECOS. If you have Medicare enrollment policy questions, please contact your Medicare contractor at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS website. Remember that for security reasons, passwords should be periodically, at least once a year. Physicians and non-physician practitioners should read and fully understand the document entitled, "Medicare Physician and Non-Physician Practitioners - Protecting Your Privacy, Protecting Your Medicare Enrollment Record." which is available at http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/MedPhysPrivac... on the CMS website.