Reviewing the PECOS Enrollment Practice Location Area for OPPS Providers Claim Submission

All off-campus OPPS locations must be identified on the enrollment record. If a hospital OPPS claim is submitted with a practice service location that was not included on the CMS-855A enrollment form OR the location reported does not exactly match the information in PECOS, it may be returned to the provider with reason code 34977.

The FISS system is mimicking the entity enrollment in PECOS. Validate the practice service location to ensure how practice locations are identified. This must be an exact match based on the information submitted on the CMS-855A application and verified through the USPS database. The USPS verified address will be entered into PECOS. Some practice locations were entered in the past and might not have the shortest USPS version. Do not forget about the ZIP + 4 digits, they too have to match.

The Service Facility Location has to be an exact match on what was verified with the USPS database and entered into PECOS.

Here are some examples:

• In PECOS on the enrollment for a practice location, the approved verified location is entered as 123 E MAIN ST, but the provider entered claim shows 123 EAST MAIN STREET on the claim submission, this does not match.
• In PECOS on the enrollment for a practice location, the approved verified location is entered as 123 EAST MAIN STREET, but the provider entered claim shows 123 E MAIN ST on the claim submission, this does not match.

Providers can review their practice locations in PECOS to ensure that their practice service location address for their off-campus provider department locations provided on claims are an exact match.

Providers must ensure that all practice locations are present in PECOS and if any locations are not in PECOS then the provider must submit to update the entity enrollment and add the practice location, which will be approved in the shortest USPS version upon completion.

Posted 8/28/2023