New Medicaid Requirements for Ordering, Referring, and Prescribing Providers

Ohio Medicaid will require any ordering, referring, or prescribing providers to be screened and enrolled as participating providers with the Medicaid program. Future guidance will be released by the Ohio Department of Medicaid (ODM) as to when the above policy change will be enforced in the claims adjudication system. Until then, claims processing and adjudication will not be impacted by this change. However, as a result of the upcoming policy change, all Medicaid providers who render and submit claims for services referred, ordered, or prescribed by non-Medicaid enrolled physicians or other health care professionals should start to prepare for future enforcement by ensuring those referring, ordering, and prescribing physicians and other health care professionals have NPIs and are enrolled in the Medicaid program. Additional implementation details will be provided for providers at a future date.