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Ordering, Referring and Prescribing (ORP)

Overview

How to avoid denied claims! Do you bill for goods or services ordered, referred or prescribed by another provider? If so, you must meet the requirements of the following billing rule or your claims will be denied.

With the implementation of the Patient Protection and Affordable Care Act (ACA) of 2010, billing providers are required to list the National Provider Identifier (NPI) and name of the provider who ordered, referred or prescribed the goods or services being billed. In addition, the ordering, referring or prescribing (ORP) provider must be enrolled as a participating provider in Medicare or Medi-Cal with their Type 1 (individual) NPI, even if the provider does not send claims directly to Medi-Cal for the services he or she furnishes.

If the ORP provider identified on your claim is not enrolled in Medicare or Medi-Cal, then your claim for reimbursement of the goods or services you provided in filling the order, referral or prescription from the ORP provider will not be paid when this policy goes into effect.

Providers and billers should monitor this page for ORP articles containing details on enforcement.

This page contains resources and information for ORP providers and billers and will be updated as more information becomes available.

Resources and Downloads

Refer to these items for more information about ORP.

Registration

Step 1: Get a Type 1 NPI

Any provider who orders, refers or prescribes goods or services to a Medi-Cal member must be enrolled in Medi-Cal or Medicare with a Type 1 (individual) National Provider Identifier (NPI). To apply for a Type 1 NPI, access the National Provider Identifier page of the National Plan & Provider Enumeration System website. Follow the instructions to get an NPI.
Note: Providers must have their own individual NPI to enroll as an ORP. Providers may not use their Type 2 (organization) NPI.

Step 2: Complete DHCS Form 6219

After obtaining an NPI, complete the Medi-Cal Ordering/Referring/Prescribing Provider Application/Agreement/Disclosure Statement for Physician and Non-physician Practitioners form (DHCS 6219). This form allows providers to enroll in Medi-Care for the sole purpose of ordering, referring or prescribing to Medi-Cal recipients.

Articles



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