Ordering, Referring and Prescribing (ORP)
Do you bill for goods or services ordered, referred or prescribed by another provider? If so, you must meet the ORP requirements 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) of the provider who ordered, referred or prescribed the goods or services being billed. In addition, the 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.
Frequently Asked Questions
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