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Enroll/Make Changes via PECOS Web

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Order, Certify and/or Prescribe Part D Drugs

Overview

Ordering, Certifying and Prescribing Physicians and Other Eligible Professionals

  • Enroll solely to order, certify and prescribe items or services for Medicare Beneficiaries
  • Will not receive reimbursement for services
  • Is not currently enrolled to receive reimbursement for services
    • Providers already enrolled to bill for services may:
      • Bill for services rendered
      • Order and Certify items or services
      • Prescribe Part D drugs
  • Only required to be enrolled in one state
  • Wants to prescribe Part D prescription drugs and has not Opted Out
    • If social security number (SSN) and National Provider Identifier (NPI) is not on Opt Out Affidavit, provider is not enrolled to order, certify and/or prescribe services
    • If SSN and NPI is on Opt Out Affidavit, provider is enrolled to order, certify and prescribe Part D drugs
  • Can change status from Ordering, certifying and Prescribing to billing for services by completing an Initial Enrollment
    • Unless provider will no longer be billing for services rendered, do not submit CMS-855O application 
  • Only required to submit an application to order and certify, Enroll for Reimbursement or an Opt Out Affidavit to be eligible to prescribe Part D drugs
  • Must submit CMS-855O application via Internet-based PECOS or via paper 

Listing

View a list of specialties able to order certify and prescribe Part D drugs.

The most up to date list of individual providers with an approved ordering/certifying/prescribing enrollment in Medicare is the CMS list of ordering/ certifying/prescribing practitioners. Verify active enrollment to order/certify/prescribe in Medicare in CMS National Ordering, Certifying, and Prescribing Database This link will take you to an external website.

  • If provider NPI is listed
    • Provider is eligible to order/certify
    • Provider is eligible to prescribe Part D drugs
    • No application is necessary
  • If provider NPI is not listed
    • Provider is not eligible to order/certify
    • Beneficiary will be denied for Part D drugs prescribed at point of sale on CMS established date
    • Submit CMS-855O application via Internet-based PECOS or via paper
  • If provider NPI is not listed but has an active I enrollment, contact the Provider Enrollment Contact Center
    • Tell the representative the national database was checked

Providers may log into CMS Internet-based PECOS This link will take you to an external website. to verify or change enrollment information at any time. Such updates include changes from ordering/referring to billing of services.

Tips

  • Ordering/Certifying means that providers want to order services for a Medicare beneficiary or refer them to another provider for services and will not receive reimbursement for services rendered
  • If a provider enrolls as an ordering, certifying, and prescribing provider, the provider has chosen not to submit services to Medicare for reimbursement
  • If enrolled as an ordering/certifying provider, provider is eligible to prescribe Part D drugs 
  • To become an ordering/certifying/prescribing provider, provider must obtain an NPI
  • To enroll as an ordering, certifying and prescribing provider, provider must complete and submit a CMS-855O form
    • One CMS-855O application will enroll a provider into nationwide program and carries over between all states

Last Updated May 25, 2017