Centers for Medicare and Medicaid Services (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 undergo a process change. These eligibility applications will now verify that the National Provider Identifier (NPI) used on the inquiry is present in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database.

  • What does this mean for me as a user?
  • Inquiries made with NPIs NOT present in the Medicare PECOS database will fail to return Medicare eligibility data.
  • 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.