New Requirement Will Affect Reimbursement Claims for Enrollees

Starting April 1, 2015, the Ohio Department of Medicaid will deny claims submitted for prescriptions unless the prescribing health care professional is actively enrolled with Ohio Medicaid. In response to changes in federal and state law, including the Patient Protections and Affordable Care Act of 2010, all prescribers who treat Medicaid patients must be enrolled as a billing provider, or alternatively, as an ordering, referring or prescribing (ORP) provider.1

Medicaid billing providers may submit claims for services rendered to patients enrolled in Ohio’s Medicaid program. ORP-only providers, however, have elected not to enroll as Medicaid billing provider but may order, refer or prescribe to patients enrolled in the program. Thereafter, the patient would seek reimbursement from Ohio Medicaid for the cost of the medication. 

In addition to the ORP registration, the prescriber’s National Provider Identifier (NPI) must be recorded on claims for prescription medications submitted to Ohio Medicaid. Failure to register with Ohio Medicaid and/or failure to include NPI information will result in the Ohio Department of Medicaid denying enrollee’s claim for the prescription. 

If not already registered as a Medicaid billing provider, it is essential that prescribers for Medicaid enrollees register with Ohio Medicaid as an ORP provider as soon as possible so that program enrollees may submit claims for prescription reimbursement. According to the Ohio Department of Medicaid, enrollment as an ORP provider can be processed in a few days. It should also be noted that ORP-only providers are not listed in the Ohio Medicaid provider directory. A link to the ORP provider application is available here: