At this time CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS. CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials. While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/referring edits will be turned on.
Physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later.
There are three ways to verify that you have an enrollment record in PECOS:
— Check the Ordering Referring Report on the CMS website, available online. If you are listed on that report, you have a current enrollment record in PECOS.
— Use Internet-based PECOS to look for your PECOS enrollment record, available at CMS.gov. If no record is displayed, you do not have an enrollment record in PECOS.
— Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS. Visit CMS.gov for the "Medicare Fee-For-Service Contact Information" list (in the "Downloads” section).
If you are not yet in PECOS, the best way to submit your application is through internet-based PECOS. For more information, visit CMS.gov.