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Health Care Training Forum

To Hospice Agency Providers Regarding ORP Guidelines

March 4, 2019

In February of 2018, MassHealth issued All Provider Bulletin (APB) 274 regarding continued implementation of the Ordering, Referring, and Prescribing (ORP) provider requirements, specifically noting the MassHealth services that require an ORP provider's NPI on MassHealth claims to be payable.

Hospice services do not require an order, referral or prescription and therefore hospice providers are not required to include an ORP provider's NPI on the claim when billing MassHealth. However, many hospice providers are including an ORP provider's NPI on their claims. When ORP provider NPI information is incorrect it triggers edits on the claims. These edits are currently informational, and are described in APB 274. Once MassHealth activates these edits, any hospice claims submitted with incorrect ORP provider NPI information will deny. To avoid future ORP-related claims denials, hospice providers should not include any ORP provider's NPI on their claims submissions to MassHealth.

If you have any questions regarding this message, please contact the MassHealth LTSS Provider Service Center at support@masshealthltss.com or call 1-844-368-5184.