Ordering/Prescribing/Referring (OPR) Providers Must Revalidate for Claims to be Paid

Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years. For many providers Medicaid payment is contingent on the ordering/prescribing/referring (OPR) provider also revalidating their enrollment in Medicaid. OPR providers who do not comply with the revalidation requirement will be terminated from the Medicaid Program. The NYS Department of Health has determined that many providers are at risk for not being paid for their services because the OPR provider has not complied with the revalidation requirement. Because this has the potential to result in significant non-payable claims for you/your facility, MDNY urges you to reach out and encourage your OPR providers to revalidate their enrollment. Please remember to confirm that your OPR provider is enrolled before rendering service at: www.emedny.org/info/opra.aspx.

Source: https://www.emedny.org/Notice/OPR_Providers_Must_Revalidate_For_Claims_To_Be_Paid_-_2-16-17.pdf