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

February 5, 2020

As announced in All Provider Bulletin 286, claims for services that require an order, referral or prescription from certain entity provider types for dates of service on or after February 15, 2020 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.  

IMPORTANT NOTE: Notwithstanding the schedule put forth in All Provider Bulletin 286, 837P claims from Acute Inpatient Hospitals, Acute Outpatient Hospitals, Community Health Centers and Hospital Licensed Health Centers for services that require orders will not be subject to denials at this time. All of the other information in the Bulletin continues to apply.

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 bulletin 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. LTSS providers should contact the MassHealth LTSS Provider Service Center at (844) 368-5184 or email support@masshealthltss.com.