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ACA Requirements for ORP Providers Available on ORP Web Page

November 18, 2015

When billing goods or services, providers are required to list the National Provider Identifier (NPI) and name of the provider who ordered, referred or prescribed goods or services. This requirement is based on the Patient Protection and Affordable Care Act (ACA) of 2010.

Each ordering, referring or prescribing (ORP) provider must be enrolled as a participating provider in Medicare or Medi-Cal, with a Type 1 (individual) NPI, even if the provider does not send claims to Medi-Cal for the services he or she provides.

In the near future, Medi-Cal will deny claims that do not meet the above requirements.

Providers seeking information about ORP requirements can now access the Ordering, Referring and Prescribing (ORP) Web page on the Medi-Cal website under the References tab. This Web page provides an overview of the ORP requirements, registration process and a list of resources.

The ORP Web page is also accessible via the Affordable Care Act (ACA) Web page.

To determine which claim form to use, providers may refer to the Navigating Medi-Cal and Specialty Health Programs chart on the Medi-Cal website.

Providers can contact the Telephone Service Center (TSC) at 1-800-541-5555 for more information. The TSC is available 8 a.m. to 5 p.m., Monday through Friday, except holidays (border providers and out-of-state billers billing for in-state providers, call 1-916-636-1200).