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ORP Billing Requirements Reminder

August 26, 2016

Claims that do not meet the Patient Protection and Affordable Care Act (ACA) ordering, referring and prescribing (ORP) provider requirements are currently receiving warnings on their Remittance Advice Details forms with RAD code 0558: The ORP Provider is not enrolled. Correct or future claims will not pay.

Billing providers must take action to correct future claim billings and become ACA compliant. Providers should check their current RAD forms to determine if they have received RAD code 0558 and consider the financial impact to the organization if claims were denied for failing to meet ORP requirements. Billing providers are encouraged to become compliant and prevent negative financial impacts to their organizations.

Resources and Downloads
Providers may refer to the following for more information about ORP.