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PECOS Medicare Review

Online administrative system healthcare providers use to enroll in Medicare

By Deb Gordon
Updated December 13, 2021
Fact checked by
Elisabeth Christopherson
Elisabeth Christopherson
Fact checked by Elisabeth Christopherson
Full Bio

Elisabeth Christopherson is an accounting professional, fact-checker, and researcher with a background in online education. She has experience reviewing and editing accounting, business, and economic publications.

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Centers for Medicare and Medicaid Services

 Centers for Medicare and Medicaid Services
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Our Take

PECOS is the Provider Enrollment, Chain, and Ownership System operated by the Centers for Medicare and Medicaid Services (CMS). PECOS is an online system for healthcare providers and suppliers to apply and enroll in the Medicare program. It is not a separate company. It does not provide Medicare insurance. Medicare enrollees would have no interaction with PECOS, but their providers use the system to enroll and update their information with CMS.

  • Pros & Cons
  • Key Takeaways
  • Company Overview
Pros & Cons
Pros

  • Centralizes provider enrollment process

  • Alternative to paper applications

Cons

  • Does not offer Medicare insurance plans

  • System weaknesses blamed for past overpayments

Key Takeaways
  • PECOS is an online system for providers and suppliers to sign up to participate in the Medicare program. 
  • It’s a single, national repository of provider and supplier information.
  • PECOS is not Medicare insurance.
  • Consumers have no interaction with the PECOS system.
Company Overview

PECOS is Medicare’s online provider enrollment management system. It is the national system CMS uses to register healthcare providers and suppliers for Medicare. It centralizes national data about Medicare providers and suppliers. PECOS launched in 2002. PECOS allows providers and suppliers to enroll, renew, or withdraw from Medicare participation and update their information electronically. It is intended to streamline the enrollment process and standardize provider and supplier enrollment data.

Geographical Restrictions

PECOS is a national system, supporting Medicare providers and suppliers across the country.

  • Year Founded 2002
  • Kinds of Plans N/A
  • Number of Plans N/A
  • Payment Options N/A
  • Customer Service Phone, email, and chat
  • Phone Number (866) 484-8049
  • Official Website pecos.cms.hhs.gov
Centers for Medicare and Medicaid Services

 Centers for Medicare and Medicaid Services
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Pros Explained

  • Centralizes provider enrollment process: PECOS creates a centralized repository of Medicare provider and supplier information. Though imperfect, this national data resource helps the government detect fraud and abuse.
  • Alternative to paper application process: Paper enrollment forms are still available, but PECOS offers providers and suppliers an online tool to apply to participate in Medicare and to update their information as needed. 

Cons Explained

  • Does not offer Medicare insurance plans: PECOS is an online system that CMS developed to enroll healthcare providers and suppliers who accept Medicare. It is not an insurance option for consumers looking for Medicare coverage. 
  • System weaknesses blamed for past overpayments: A 2016 Government Accountability Office (GAO) report showed PECOS weaknesses contributed to nearly $60 billion in Medicare overpayments. 

Available Plans

PECOS doesn’t offer Medicare insurance plans or services for consumers. It is not a separate company, but a system operated by CMS to enroll providers and suppliers into the Medicare program. It’s a national database to store provider and supplier information. 

What You Need to Know

PECOS doesn’t sell Medicare insurance; it’s the CMS enrollment system for Medicare providers and suppliers.

PECOS is one of several administrative systems CMS uses to manage provider participation. Providers must first set up an account in the Identity and Access Management (I&A) system, which allows them to manage access to the other relevant systems, including PECOS. Through their I&A account, providers can add staff users, modify roles, and create connections between the provider and other organizations. 

Once the I&A account is set up, providers must establish a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). NPIs are identification numbers unique to individual healthcare providers or healthcare organizations and are required under the Health Insurance Portability and Accountability Act (HIPAA) for administrative and financial transactions, such as filing claims or getting paid.

Once providers and suppliers are set up in those systems, they can enroll in the Medicare program to provide and get paid for Medicare services. Providers can apply to participate in Medicare through PECOS or via paper enrollment forms. Once in the Medicare program, providers use PECOS to update their information as needed.

Customer Service

CMS’ External User Services (EUS) provides user support for the PECOS system via phone, email, or chat on the EUS website.

Telephone: (866) 484-8049, Monday through Friday, 7 a.m. to 7 p.m. EST

Email: EUSSupport@cgi.com

Chat via the EUS website, Monday through Friday, 7 a.m. to 7 p.m. EST

Customer Satisfaction 

In recognition of opportunities to improve customer or user satisfaction and overall system performance, CMS requested $40.5 million for the ongoing development of a new version of the system, PECOS 2.0, in the FY 2020 budget. The updates include an improved user interface, streamlined application processing, adaptations to evolving industry trends, and greater automation.

CMS also intends to begin coordinating with state Medicaid agencies and other CMS programs to be able to use PECOS in a wider range of Medicare programs; currently, it is used for the fee-for-service Medicare program, often referred to as Original Medicare. 

What You Need to Know

PECOS does not support consumers or offer customer service directly to Medicare enrollees. 

Third-Party Ratings

In 2016, the Government Accountability Office (GAO) released a report that showed flaws in PECOS had contributed to overpayments. According to the report, in 2015, CMS had improperly paid $59.6 billion, 10.5% of all Medicare payments for healthcare and related services that year. The GAO found that in 2013, 23,400 (22% of practice locations) were potentially ineligible but that the system had not flagged the potential issues. 

The report also found that 147 out of 1.3 million physicians included in PECOS had received a final adverse action against their medical license but had not been removed from the system. Final adverse actions could reflect serious issues such as a federal sanction against the provider, a felony or misdemeanor conviction, or the suspension or revocation of their medical license or accreditation. The PECOS system had not been collecting historical adverse action information or alternate medical license information that a provider may have used in a different state. The report included several process improvement recommendations.

Cost

There are no consumer costs for the PECOS system. Institutional providers and suppliers pay an application fee when they enroll, re-enroll, revalidate, or add a new practice location. These suppliers include those who provide durable medical equipment, prosthetics, orthotics as well as opioid treatment programs, and Medicare diabetes prevention programs. The application fee in 2022 is $631. Physicians and other healthcare providers and provider organizations do not pay an application fee.

Competition: PECOS vs. UnitedHealthcare

PECOS is not Medicare insurance, but an administrative system CMS uses to manage healthcare provider and supplier enrollment. If you need Medicare coverage, there’s a good chance UnitedHealthcare offers options for you. It offers many different types of Medicare insurance plans, including Medicare Advantage plans in 47 states. 

UnitedHealthcare is the nation’s largest health insurer and one of the largest Medicare Advantage plans in 2021. UnitedHealthcare earns relatively high quality scores and is the only Medicare insurance company to offer plans in partnership with AARP. UnitedHealthcare has more than 6.5 million Medicare Advantage members, so you’ll be in good company if you choose one of their plans.

  PECOS UnitedHealthcare
Number of States Available 50 47 (for Medicare Advantage)
Medicare Services Provider and supplier enrollment Medicare Advantage HMO, HMO-POS, and PPO Plans; Private Fee-for-Service (PFFS) Plans;
Stand-alone Prescription Drug Plans (PDP); Dual-eligible Special Needs Plans (D-SNP); Medicare Supplement Insurance (Medigap) Plans
Customer Service Options Phone, email, chat Telephone, online, in person, chat
AM Best Rating N/A A- (Excellent)
Average CMS Star Rating N/A 3.78
Verdict

PECOS is not a Medicare insurance plan. It is an administrative system that CMS developed to onboard its providers and suppliers, and manage the database of provider and supplier information. If you’re looking for Medicare coverage, check our recommendations for the best Medicare Advantage Plans.

How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index, and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

Article Sources
Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy.

  1. CMS.gov. "Subject: DME MAC and NSC MAC Processing 'Do Not Forward' Code Notification and Action," Page 3.

  2. United States Government Accountability Officer. “Continued Action Required to Address Weaknesses in Provider and Supplier Enrollment Controls,” Page 2 of PDF.

  3. Department of Health and Human Services. “Fiscal Year 2020, Centers for Medicare and Medicaid Services,” Page 128.

  4. United States Government Accountability Officer. “Continued Action Required to Address Weaknesses in Provider and Supplier Enrollment Controls,” Pages 1, 4, 10, 13.

  5. CMS Medicare Learning Network. “Medicare Provider Enrollment Application Fee.”

  6. Kaiser Family Foundation. “Medicare Advantage 2021 Spotlight: First Look.”

  7. Becker’s Payer Issues. “10 Largest Health Insurers.”

  8. UnitedHealthcare Group. "UnitedHealthcare’s 2021 Medicare Plans Bring Unique Solutions for Unique Times."