An application sits for nine weeks. The Medicare contractor gives a slightly different answer on every call, and then a development request arrives asking for something the practice already sent. More often than anyone expects, the cause is NPPES PECOS alignment: a record that says one thing in NPPES and something slightly different in PECOS, or a staff member without the I&A role to fix either one.
What the free alignment audit looks like
Page one sets who completes it and what decision it supports. The last pages turn your answers into an alignment result and a correction plan.
Three systems, one provider, and records that must stay aligned
NPPES holds the NPI. PECOS holds the Medicare enrollment record, and Identity & Access decides who can work in either one. Some information may be exchanged between CMS systems, but updates should be verified in both NPPES and PECOS to confirm that the applicable records remain complete and consistent. Updating one does not guarantee alignment in the others, so NPPES PECOS alignment has to be checked provider by provider.
30 calendar days
What Medicare allows to answer a request for missing information. If the deadline is missed, the application may be rejected without appeal rights. A rejected application must be resubmitted, creating a new filing date and potentially affecting the effective date.
That is why a small mismatch costs more than it looks. For how long each payer typically takes once a file is clean, see HRG's guide to Medicare provider enrollment.
What is inside the free alignment audit
- 29 checks across NPPES, I&A access, connections, and PECOS, each marked BLOCKER or RISK, so you know which gaps stop a filing and which only slow it
- A trigger-event log for the seven changes that knock records out of line, from a provider leaving to an Authorized Official changing
- A symptom-to-cause table that traces a stalled file back to the record or role behind it
- An alignment result, your top three gaps, and a dated correction plan with an owner on every step
It is a 10-page fillable PDF for the people who already work in these systems. Plan on about 30 minutes per provider the first time through.
How HRG keeps Medicare records aligned
HRG's U.S.-based team reconciles provider and organization data across NPPES, PECOS, CAQH, now DataSpring, and the payer records before anything is filed. Then it pushes. The team follows up on every open file weekly and escalates any application that stalls. When a file is already stuck, it traces whether the roadblock is a record mismatch or a missing role and works it at the source. The Medicare contractor decides when enrollment takes effect, but HRG doesn't let a file sit. HRG has done this for 26 years, and its credentialing and contracting service runs month to month, with no minimum fee and no long-term contract.
"Easy to reach, great communication, and the consistent updates on the progress helps put me at ease with the process."Dr. Daryl Augustine, Podiatrist and Owner, Daryl J Augustine DPM PC
A note on scope. NPDB queries, credentialing committee determinations, exclusion screening decisions, privileging approvals, and FTCA deeming remain the responsibility of the practice or health center under federal and HRSA guidelines. A credentialing partner like HRG supports the surrounding workflow. That includes documentation, tracking, payer follow-up, file management, and reporting. The organization retains authority over decisions that require its direct attestation and oversight.
Before you download
Who is the alignment audit for?
Credentialing staff, practice administrators, and billing leads who work in NPPES, I&A, or PECOS and want fewer surprise development requests. It assumes you already know what PECOS is.
How long does it take?
About 30 minutes per provider on the first pass. After that, you update the trigger-event log whenever something changes, such as a new location or a departing provider.
Does it depend on our credentialing or practice management software?
No. It follows CMS's own systems, so it works the same whatever software your team uses.
Can HRG fix a file that is already stalled?
Yes. HRG reviews where the file stands, finds the mismatch or missing role, and works it through with the Medicare contractor.
Get the free NPPES, I&A, and PECOS Alignment Audit
"A rare ability to anticipate potential issues before they become problems."Dr. Allen Silvey, Founder and CEO, MedCorps Asthma and Pulmonary Specialists, on working with Mellissa Harmon
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