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PECOS Enrollment Status Lookup
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Healthcare Provider Verification Terminology
16 TermsNPI (National Provider Identifier)
CoreA unique 10-digit identification number issued by CMS for healthcare providers in the United States. Required for Medicare billing and other health plan transactions under HIPAA. Every healthcare provider who conducts electronic transactions must obtain an NPI.
Example: 1234567890 (always exactly 10 digits)
PECOS (Provider Enrollment, Chain, and Ownership System)
CoreMedicare's online enrollment system for healthcare providers and suppliers to enroll, make changes to existing enrollment data, view enrollment status, and electronically sign certification statements. Essential for Medicare reimbursement eligibility.
Programs: Part B, DME, HHA, PMD, Hospice
Provider Type
CoreClassification of healthcare providers based on their services and credentials. Different provider types have specific enrollment requirements, billing rules, and regulatory oversight.
Types: Individual (physicians, NPs), Organizational (hospitals, clinics), Suppliers (DME)
Taxonomy Code
CoreA standardized classification system for healthcare provider specialties and subspecialties used in HIPAA transactions. Helps identify the specific type of healthcare services a provider offers.
Format: 10-character alphanumeric code (e.g., 207R00000X for Internal Medicine)
Medicare Enrollment Status
EnrollmentIndicates whether a provider is actively enrolled in Medicare and eligible to bill for services. Critical for determining reimbursement eligibility and compliance status.
Statuses: Enrolled, Pending, Deactivated, Revoked, Rejected
Revalidation
EnrollmentThe process requiring Medicare providers to resubmit and recertify their enrollment information every 3 or 5 years to maintain Medicare billing privileges. Failure to revalidate results in deactivation.
Cycles: Individual providers (5 years), Organizational providers (5 years), DME suppliers (3 years)
Effective Date
EnrollmentThe date when a provider's Medicare enrollment becomes active and they can begin billing Medicare for covered services. This date is crucial for claims processing and reimbursement.
Practice Location
EnrollmentThe physical address where a provider delivers healthcare services to Medicare beneficiaries. Must be updated in PECOS when providers change locations to maintain compliance.
OIG Exclusion List
ComplianceA database maintained by the Office of Inspector General listing individuals and entities excluded from participating in federal healthcare programs. Providers must verify they are not excluded.
Also Known As: LEIE (List of Excluded Individuals and Entities)
CMS-855 Application
ComplianceThe standardized enrollment application form used by providers to enroll in Medicare. Different versions exist for different provider types (855I for individuals, 855O for organizations, etc.).
Lookback Period
ComplianceThe timeframe during which CMS reviews a provider's history for compliance issues, criminal background, and other eligibility factors during the enrollment process.
Deactivation
ComplianceThe temporary suspension of a provider's Medicare billing privileges, often due to failure to revalidate enrollment or respond to CMS requests for information.
Batch Monitoring
TechnicalA feature that allows tracking multiple providers simultaneously for changes in their enrollment or credentials status. Enables automated monitoring and alerts for compliance teams.
NPPES (National Plan and Provider Enumeration System)
TechnicalThe system that assigns and maintains National Provider Identifier (NPI) numbers. Contains publicly available information about healthcare providers.
API Integration
TechnicalApplication Programming Interface connections that allow automated retrieval and synchronization of provider data from official registries and databases.
Real-time Alerts
TechnicalAutomated notifications triggered when provider status changes occur, enabling immediate response to compliance issues or enrollment updates.
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Provider Status Monitoring
Scheduled ChecksSet up automated monitoring for your providers' enrollment status.
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You need to log in or register to use the monitoring features.
Quick Actions
Control Center
Manage your monitoring setup and system preferences
Monitoring Batches
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Batch Details
Select a batch to view details
The monitoring module allows you to track changes in NPI and PECOS enrollment
status for
your providers over time.
Automated Monitoring
Set up automated checks for your providers' NPI and PECOS enrollment status with customizable frequencies.
Real-time Alerts
Get notified immediately when provider status changes are detected via email or webhook notifications.
Analytics & Reports
Track changes over time with detailed analytics, export capabilities, and comprehensive reporting.