ORP Provider Validation Lookup Tool Beta Release

May 24, 2017

Medi-Cal is in the process of implementing the Patient Protection and Affordable Care Act (ACA) Ordering, Referring and Prescribing (ORP) requirements. To support billing providers’ compliance with these requirements, Medi-Cal has created the ORP Provider Validation Lookup Tool. The web-based tool gives billing providers the ability to verify an ORP provider. This is done using the ORP provider Type 1 (individual) National Provider Identifier (NPI) to verify that an ORP provider is known to Medi-Cal and if the ORP provider is active for the specified date of service in advance of billing Medi-Cal. This will allow the billing provider to resolve any issues with invalid NPIs or non-enrolled ORP providers before submitting a claim.

A beta version of the ORP Enrollment Validation Lookup Tool has been released. Please use the beta version of the tool to set up processes and procedures for validating ORP provider enrollment when fulfilling/billing a service. Medi-Cal will release a final version of the tool prior to enforcing ORP requirements on claims (that is, denying claims for failure to provide a valid Type 1 [individual] NPI for an enrolled ORP provider).

The tool will validate ORP provider enrollment and display a response along with a transaction number. Users should record the transaction number in the event of a discrepancy between the ORP Enrollment Validation Lookup Tool response and claim adjudication.

The ORP Provider Validation Lookup Tool can be accessed from the Ordering, Referring and Prescribing (ORP) Web page on the Medi-Cal website along with more information and frequently asked questions about ORP requirements.

Click on the ORP Enrollment Validation Lookup link to verify ORP Medi-Cal enrollment status. For instructions on how to use the tool, refer to the ORP Provider Enrollment Validation Lookup Tool Guide.

Providers with additional questions may contact the Telephone Service Center (TSC) at 1-800-541-5555.