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Ordering, Referring, and Prescribing Provider NPI Clarification

July 23, 2018

All Provider Bulletin 274, posted on 02/08/2018, was released with the intent to assist billing providers as they prepare their processes and systems for compliance with MassHealth's Ordering, Referring, and Prescribing (ORP) requirements, and to reduce the impact once claim denials take effect.  MassHealth is preparing for, but has not yet established, a date to begin denying claims that do not meet the ORP requirements. MassHealth will communicate the start date for claim denials prior to beginning such denials. 

This communication is a reminder that all NPIs submitted in the ordering or referring loop on a claim for Ordering, Referring, or Prescribing purposes must be an individual provider's NPI and the individual provider must be in an authorized ORP provider type (as listed in All Provider Bulletin 274).  Our reports show that many billing providers are submitting their entity, or facility, or group NPI on the submitted claims. 

To check to see if an individual provider is enrolled with MassHealth, please utilize the online provider directory on our Provider Online Service Center (POSC) at:

https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal.To register for the POSC, instructions may be found at https://tinyurl.com/y9th3e47.

Instructions on how ORP providers can enroll can be found at: https://www.mass.gov/how-to/how-to-enroll-to-be-a-masshealth-orp-provider.

If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail providersupport@mahealth.net.

If you are an LTSS Provider and have any questions, please contact the MassHealth LTSS Provider Service Center at 1-844-368-5184 or e-mail support@masshealthltss.com.