Surrogate PECOS program allows you to ‘officially’ aid with provider enrollment

January 3rd, 2014 - Scott Kraft
Categories:   Enrollment  

One of the biggest frustrations practices have had with enrolling providers under Medicare’s Provider Chain Enrollment Ownership System – PECOS for short – is the requirement that the providers personally enter much of the data needed to enroll or revalidate enrollment information.

Now that’s changed. As of Oct. 7, CMS has deployed a “surrogate” program allowing providers and practices to delegate enrollment and revalidation functions to members of the staff.

To get started, any employee of the group practice can enroll in the PECOS I&A system (

Enrollment requires the user to have a unique email address and password, which will then be confirmed by the system sending an email to that address.

In addition, identification of each person seeking access through the system will be validated in a manner similar to how a credit bureau might validate information about someone. Expect to be asked a series of specific, personal questions such as whether you had a specific car loan or mortgage at a specific period of time.

The applicant would also send a paper application for CMS to review, a process expected to take 2-3 weeks in total. If an applicant is denied, he or she may reapply immediately.

One approved, the applicant who wishes to act as a surrogate and the provider who wishes to deploy a surrogate would connect in a way that is a little similar to how friends are made on Facebook.

The surrogate would send a request for access to the provider, who would then need to log into PECOS and approve the request. No email would be sent to prompt the provider, so it’s important that the provider be reminded that action is needed. Once permission is granted, it is effective in real time.

Note that the surrogate would gain access to the provider’s entire record in PECOS. The provider may also grant access to his or her record for the Electronic Health Records (EHR) Incentive Program and the National Plan and Provider Enumeration System (NPPES). The NPPES access would not take effect immediately as the system is not yet ready, according to CMS.

Remember, the approval is for each of the three systems and the provider is not able to restrict subsets of information within each of those systems. It’s all or nothing. You must also remember that, if an employee leaves your organization who is authorized to act as a surrogate, each provider must log into the I&A system and revoke the surrogate authorization immediately.

The revocation will also be done in real time and take effect immediately. But you’ll be exposed until such time as it is done, so be sure to add it to your employee exit interview or exit process.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association