Ordering, Referring and Prescribing (ORP)

Overview

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

• ORP Frequently Asked Questions

Resources and Downloads

• ORP Enrollment Validation Lookup
  This tool is used to validate ORP provider enrollment.
• ORP Enrollment Validation Lookup Tool User Guide
  ORP Enrollment Validation Lookup Tool User Guide
• Ordering/Referring/Prescribing Brochure
  This brochure has more information about ORP requirements.
• Medi-Cal Ordering/Referring/Prescribing Provider Application Instructions and Requirements
  This document contains instructions for becoming an ORP provider.
• Updated ACA Billing and Enrollment Requirements for ORP Providers
  This is the regulatory provider bulletin that establishes ORP provider requirements for the Medi-Cal Program.
• Medi-Cal ORP Provider Enrollment Directions (Registration)
  This document provides the steps and links to enroll as an ORP provider.
• ORP Provider Readiness Checklist

Articles

• RAD Code 0558 Turned Off for LTC and Inpatient Claims