Attention: All Providers Medicaid Special Bulletin Regarding OPR Changes Effective November 1

The N.C. Division of Medical Assistance (DMA) has posted a Medicaid Special Bulletin titled "Update - Federal Regulations: 42 CFR 455.410 Attending, Rendering, Ordering, Prescribing or Referring Providers and 42 CFR 455.440 National Provider Identifier." This is the first article in a two-part series of Special Bulletin articles to announce the upcoming changes effective November 1, 2016.

Health care practitioners who order, prescribe, refer or render services to N.C. Medicaid or N.C. Health Choice (NCHC) beneficiaries must be enrolled in those programs. Prior to November 1, 2016, providers received a “pay and report” edit on their Remittance Advice (RA) if they submitted National Provider Identifiers (NPI) on their claim but the NPI was not enrolled in either program. Effective with dates of service on or after November 1, 2016 , the edit will change from “pay and report” to “suspend.” This change will have a number of impacts on providers. These impacts, as well as required data elements and edit disposition changes are described in this bulletin. This supersedes all Medicaid bulletin articles before September 2016.

All providers are encouraged to read this important information about changes coming to NCTracks on November 1, 2016.