Nev. Medicaid Provider Type 64 (Hospice) Billing Guide, Ordering, Prescribing or Referring (OPR) Provider Requirements

The Patient Protection and Affordable Care Act and the Centers for Medicare & Medicaid Services (CMS) require all ordering,

prescribing and referring physicians to be enrolled in the state Medicaid program (§455.410 Enrollment and Screening of

Providers). The Affordable Care Act (ACA) requires physicians or other eligible practitioners to enroll in the Medicaid

program to order, prescribe and refer items or services for Medicaid recipients, even when they do not submit claims to

Medicaid. Physicians or oth er eligible professionals who are already enrolled in Medicaid as participating providers and

who submit claims to Medicaid are not required to enroll separately as OPR providers.

For any services or supplies that are ordered, prescribed or referred, the National Provider Identifier (NPI) of the Nevada

Medicaid-enrolled Ordering, Prescribing or Referring (OPR) provider must be included on Nevada Medicaid/Nevada Check

Up claims or those claims will be denied. To prevent claim denials for this reason, please confirm that the OPR provider is

enrolled with Nevada Medicaid; this can be done on the Provider Web Portal by using the Search Providers feature:

medicaid.nv.gov/hcp/provider/Resources/SearchProviders/tabid/220/Default.aspx

Reminders for providers who submit institutional claims:

• If your provider type requires the attending physician to be listed on the Institutional claim, that attending

physician must be enrolled with Nevada Medicaid.

• If the service was ordered, prescribed or referred by another provider, the NPI of the OPR provider is required to

be listed on the claim form. The OPR provider must be enrolled in Nevada Medicaid.

• If the attending physician is the same as the OPR provider, leave the OPR field blank.

• The attending and OPR NPI must be for an individual provider (not an organization or group).

• For detailed claim completion information, refer to the 837I FFS Companion Guide and the PWP User Manual

Chapter 3.