NPI/NPPES PECOS CAQH


NPPES Snippet

NPI stands for National Provider Identifier and NPPES is the National Plan and Provider Enumeration System. You are responsible for keeping the information attached to your NPI, and thereby what is in the NPPES, up to date. You must register to do so. Payors may base release of payment on the information in this database and your colleagues will access it to locate you, so it behooves you to keep it current and accurate.  The NPI/NPPES database can be searched by anyone with internet access – no data other than public, non-personal information is viewable through the search process. It is free and the database is password protected and secure.

PECOS stands for Provider Enrollment, Change, and Ownership System, which can be confusing. You are required to keep this information up to date as well. As of 2013, there is now a fee associated with Medicare applications whether paper or internet based.

NPI NPPES and PECOS are NOT the same thing.

CAQH

CAQH is a voluntary database used by providers to store expireables and demographic information to be easily accessed by credentialing agents. In theory, any entity that has access to your CAQH data should not need to contact your staff for expireables. There is NO CHARGE to participate in the database - it is a secure database so your information is protected. You will complete a computer based questionnaire about you, your practice, your training, hospital affiliation, etc. Your staff will fax copies of your expireables in to CAQH and going forward you’ll share the information ONCE with CAQH and then directing appropriate credentialing inquiries to CAQH. As of this time, some hospitals, Medicare, and Medicaid do NOT accept CAQH and will continue to require you give the information to them directly. However, Beech Street, Blue Cross, Coventry, First Health, Humana, United Health Care, CIGNA, and more do have working relationships with CAQH so this can save you and your staff a great deal of time and money. You must register and set up a user ID and password.