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Start Date for Denials for Certain Claims That Do Not Meet Ordering, Referring, And Prescribing Provider Requirements

December 2, 2019

As announced in All Provider Bulletin 286 claims for services that require an order, referral or prescription from certain individual provider types for dates of service on or after December 15, 2019, will not be payable if they do not include the National Provider Identifier (NPI) of an authorized ordering, referring, prescribing (ORP) provider on the claim. Please see All Provider Bulletin 286 for detailed information about impacted services and billing providers and for the placement of the ORP NPI on impacted claims.

Providers receiving such denials should review the bulletins and the ACA ORP Requirements for MassHealth Providers page on mass.gov or you may contact the MassHealth Customer Service Center at (800) 841-2900 or providersupport@mahealth.net for assistance in correcting and resubmitting the denied claims.