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New NPI Verification Process through PECOS

There has been an important update from the Centers for Medicare and Medicaid Services (CMS).

CMS has notified ABILITY that as of April 1, 2019 mainframe eligibility applications hosted in Direct Data Entry/Fiscal Intermediary Standard System (DDE/FISS) and Common Working File (CWF) will be undergoing a process change. Users attempting to verify Part A Medicare eligibility benefits will be required to use a National Provider Identifier (NPI) that is registered in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database. As part of the eligibility process, these eligibility applications will now verify that the NPI used on the inquiry is present in the Medicare PECOS database.

What does this mean for Ability Network users?

Inquiries made with NPIs NOT present in the Medicare PECOS database will fail to return Medicare eligibility data.

Your ABILITY account includes access to these systems. We are proactively reaching out to make sure you’re aware of this change and to provide you the resources you need to either verify or register your NPI with PECOS.

What are my next steps?

ABILITY recommends that you review the PECOS status for any NPIs currently used by your organization. If your NPIs are not currently registered with PECOS, update that information accordingly. Additional information on PECOS and how to register your NPI can be found by clicking here.