Ordering/Referring Editing Implementation

The October 1, 2013 implementation of new claims editing requiring Medicaid enrollment for ordering/prescribing/referring/attending (OPRA) physicians and healthcare professionals has been delayed until January 1, 2014. The extended implementation will allow for more time for OPRA providers to request and obtain enrollment. Providers who have submitted enrollment applications will be notified by letter when a determination has been made or if the application was missing information. Providers who have not yet submitted enrollment applications must do so immediately to avoid future interruption of the services they order for their patients. The enrollment requirement applies to all services provided under the Medicaid state plan or under a waiver of the state plan. It does not apply to services paid though a Medicaid managed care plan.

Source: https://www.emedny.org/Notice/Ordering_Referring_Editing_Implementation_NOTICE.pdf