What is PECOS?

PECOS (Provider Enrollment, Chain, and Ownership System) is the CMS system that manages Medicare provider and supplier enrollment. It is the authoritative source for determining whether a healthcare provider is enrolled in Medicare and eligible to order, refer, or bill for Medicare services.

Why Does PECOS Matter?

PECOS enrollment is critical for healthcare billing because:

• Claims denial: Medicare claims will be denied if the ordering/referring provider is not enrolled in PECOS
• DME orders: DME suppliers cannot bill Medicare for items ordered by a provider who is not PECOS-enrolled
• Referrals: Referrals from non-enrolled providers are not accepted by Medicare
• Home Health: Home health agencies need face-to-face encounters certified by PECOS-enrolled physicians

PECOS Enrollment Categories

When you look up a provider on LookupNPI, you'll see their enrollment status across these categories:

How DME Companies Use PECOS

For DME suppliers, verifying PECOS enrollment is a critical step before processing any Medicare order:

1. Receive a prescription/order from a physician
2. Look up the ordering physician's NPI number
3. Verify they are PECOS-enrolled with DME ordering privileges
4. If not enrolled, the claim will be denied - contact the physician or find an enrolled provider

Order and Referring Database

CMS maintains the Order and Referring database, which lists all providers eligible to order and refer for Medicare services. Our tool checks this database in real-time when you look up an NPI number.