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ORP Guidelines for Day Habilitation Providers

February 3, 2020

Day Habilitation providers should not include any Ordering, Referring, and Prescribing (ORP) provider's National Provider Identifier (NPI) on claim submissions to MassHealth. 

In September of 2019, MassHealth issued All Provider Bulletin (APB) 286 (which superseded APB 259 and 274) and specifically noted the MassHealth services that require an ORP provider's NPI on MassHealth claims to be payable.

As indicated in the Bulletin, Day Habilitation services do not require an order, referral, or prescription, and therefore Day Habilitation providers are not required to include an ORP provider's NPI on the claim. However, many Day Habilitation providers are including an ORP provider's NPI on their claims. When ORP provider NPI information is submitted, it triggers edits on the claims. These edits are currently informational for certain providers as described in APB 286. Once MassHealth activates these edits, however, any Day Habilitation claims submitted with ORP provider NPI information may deny. To avoid future ORP-related claim denials, Day Habilitation providers should not include any ORP provider's NPI on claim submissions to MassHealth.

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