Beginning on October 5th, if the name of an ordering/referring provider appears on a Medicare claim, this provider will be compared against the Provider Enrollment Chain and Ownership System (PECOS). Between this date and January 3, 2010, if the referring provider is not found in the PECOS system, informational claim adjustment reason codes and remittance advice remark codes will appear on the explanation of Medicare benefits stating that the ordering/preferring provider identifier is invalid.
Beginning on January 4th, 2010, any claims that include invalid referring physician information will be denied. In addition, any provider who does not appear in the PECOS system with up-to-date information runs the risk of being excluded from the Medicare program for a period of one year.
It is imperative that Medicare remittance advice be watched very closely during this Phase 1 period. For providers who rely on patient referrals for the bulk of their business, such as specialists and laboratories, any warnings received should be shared with the referring providers in question to bring this situation to their immediate attention, as continued non-compliance with this enrollment rule by referring or ordering providers could lead to your claims being denied.
Fortunately, the PECOS system has simplified what can be a laborious enrollment process. Simply go here to begin the process and follow the step-by-step on-screen instructions. After completing this process, remember to sign and return the two-page certification form within seven days of you PECOS submission. Your information in the PECOS system will not be completed without this step. If you have previously registered with the PECOS system, go here to login to the system and update your information. If you experience technical difficulties during the process, CMS offers help desk support from 7 AM to 7 PM Eastern Time Monday thru Friday either by calling 1-866-484-8049 or by e-mailing .