September 27, 2022

Volume XII, Number 270

Advertisement

September 27, 2022

Subscribe to Latest Legal News and Analysis

September 26, 2022

Subscribe to Latest Legal News and Analysis
Advertisement

Ohio Law Changes Influencing Prescriber Enrollment in Medicaid

Starting April 1, 2015, the Ohio Department of Medicaid will deny claims submitted for prescriptions unless the prescribing health care professional is actively enrolled with Ohio Medicaid. In response to changes in federal and state law, including the Patient Protections and Affordable Care Act of 2010, all prescribers who treat Medicaid patients must be enrolled as a billing provider, or alternatively, as an ordering, referring or prescribing (ORP) provider.

Medicaid billing providers may submit claims for services rendered to patients enrolled in Ohio’s Medicaid program. ORP-only providers, however, have elected not to enroll as Medicaid billing provider but may order, refer or prescribe to patients enrolled in the program. Thereafter, the patient would seek reimbursement from Ohio Medicaid for the cost of the medication.

In addition to the ORP registration, the prescriber’s National Provider Identifier (NPI) must be recorded on claims for prescription medications submitted to Ohio Medicaid. Failure to register with Ohio Medicaid and/or failure to include NPI information will result in the Ohio Department of Medicaid denying enrollee’s claim for the prescription.

If not already registered as a Medicaid billing provider, it is essential that prescribers for Medicaid enrollees register with Ohio Medicaid as an ORP provider as soon as possible so that program enrollees may submit claims for prescription reimbursement. According to the Ohio Department of Medicaid, enrollment as an ORP provider can be processed in a few days.

© 2022 Dinsmore & Shohl LLP. All rights reserved.National Law Review, Volume V, Number 96
Advertisement
Advertisement
Advertisement
Advertisement

About this Author

Daniel S. Zinsmaster, Dinsmore Law Firm, Health Care Lawyer
Partner

Dan provides trusted counsel and advocacy to health care clients on a variety of matters, such as corporate compliance, provider credentialing, administrative proceedings and litigation.  He also advises clients on practice formation and acquisition, as well as contract review and preparation.  In recent years, Dan has helped health care companies and providers navigate through fraud and abuse investigations, antitrust reviews, and other white collar criminal matters.  He is a frequent author and lecturer on telehealth and telemedicine issues.

...

(614) 628-6949
Advertisement
Advertisement
Advertisement