Abbreviated Application for Ordering, Prescribing and Referring Practitioners

[Article reprinted from the August 2017 Medicaid Bulletin]

Effective October 29, 2017, an abbreviated enrollment application will be available for ordering, prescribing, and/or referring (OPR) practitioners. As required by 42 CFR 455.410, physician and non-physician practitioners who solely order, refer, or prescribe items for NC Medicaid or NC Health Choice (NCHC) beneficiaries must enroll in the Medicaid program. OPR practitioners can request a retroactive effective date up to 365 days preceding the date of application.

Physician and non-physician practitioners may elect to enroll as OPR-only providers (OPR lite). Billing providers will use the NPI (National Provider Identifier) of the OPR lite provider on their claims when these providers order or refer items or services. NCTracks will not reimburse OPR lite providers when their NPI is used as rendering or attending on a claim.

The following enrollment requirements will apply to OPR lite providers:

• Revalidate every five years ï‚·
• $100 application fee ï‚·
• Credentialing and Background Checks including fingerprinting, if applicable
• Manage Change Request (MCR) submission to update or end date the provider record ï‚·
• MCR to change from an OPR lite enrollment provider to a fully enrolled provider if they are to be reimbursed for claims.

Out-of-state and border providers are subject to the fingerprinting requirement. They may have the process completed in their home state and results stored in PECOS or verified through the state Medicaid agency. If the owner is out-of-state, that owner would be required to fingerprint in their home state and send the evidence to NC Medicaid.

Note: OPR lite providers also request a retroactive effective date up to 365 days preceding the date of application.