Current state and federal regulations (13 CSR 65-2 and 42 CFR 455.410) require ordering, prescribing or referring (OPR) providers to enroll with Medicaid, even if they do not accept Medicaid. In response, MO HealthNet has begun implementing changes in the claims processing system to deny all claims that require an order, prescription or referral from a physician or other licensed health care professional unless that physician or provider has an active enrollment record on file.
The Mo Healthnet Remittance Advices for Durable Medical Equipment (DME), Independent Laboratory medical claims, Imaging medical claims, and Home Health claims contain the following alert when the ordering, prescribing, or referring provider on the claim is not an actively enrolled provider:
| N613 | Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future. |
In November, 2017, the claims will begin to deny unless the ordering, prescribing, or referring provider information is on the claim, and the provider is enrolled with MO HealthNet.
In order to assist with this process, the Missouri Medicaid Audit and Compliance Unit (MMAC) provides an OPR Provider Application. This form is fillable.
MMAC’s provider enrollment personnel will expedite all OPR applications received.
For more information please choose “Providers” from the MMAC home page, and then choose “Provider Enrollment” and then choose “Ordering, Prescribing, and Referring” providers.
Please submit any questions to MMAC.ProviderEnrollment@dss.mo.gov