Implementation of the Ordering, Prescribing, and Referring (OPR) Claim Edits

The Affordable Care Act (ACA) requires that ordering, prescribing and referring providers who render services to patients be enrolled in the Connecticut Medical Assistance Program (CMAP).  Non-crossover claims submitted with dates of service on or after 11/1/2013 will begin to deny and post EOB 1035 “Referring provider not enrolled on date of service” and EOB 1036 “Ordering provider not enrolled on date of service” on the provider’s RA if the referring or ordering provider submitted on the claim is not an enrolled provider on the date of service. Effective with claim dates of service 12/1/2013 and forward, Medicare Part B Crossover claims will begin to deny.

Source: https://www.ctdssmap.com/CTPortal/Information/Get Download File/tabid/44/Default.aspx?Filename=pb13_61.pdf&URI=Bulletins/pb13_61.pdf