Ordering and Referring System Changes
June 28, 2016State law requires that all claims for payment for items and services that were ordered or referred to contain the NPI of the physician or other professional who ordered or referred such items or services. In order to comply with this requirement, the ordering or referring NPI on the claim must be for an individual, not for a group. Additional system edits went into effect on 6/16/2016 to comply with this requirement. After going into effect, more claims related to the referral edits denied than anticipated. Therefore, in order to allow providers more time to prepare for this requirement, MDOK has temporarily removed the referring NPI edits.