At this time, the Centers for Medicare & Medicaid Services (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 because such provider is not in an approved file in PECOS (the Medicare online enrollment system). CMS is working diligently to resolve the backlog of enrollments and other systems issues. It will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials. CMS has not announced a definitive date 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. Once CMS turns on this edit function, claims will be denied if a provider is not in PECOS. To verify that you have an enrollment record in PECOS:
- Check the Ordering Referring Report on the CMS website, available here. 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 here. If no record is displayed, you do not have an enrollment record in PECOS.
- Check TrailBlazer Web site verification options, click here.
If you are not yet in PECOS, the best way to submit your application is through internet-based PECOS.