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Be sure to get ‘set up’ with the Medicaid program
e-Reports, Sept. 4, 2012
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TRIAGE: COMMUNICATING, INTERPRETING, EXPLAINING IMPORTANT NEWS FOR YOUR PRACTICE Untitled document

Indiana Health Coverage Programs (IHCP) has announced a change, effective Oct. 1, involving a special provider type enrollment for physicians NOT enrolled in Medicaid but who write prescriptions, order supplies or refer Medicaid patients. After the effective date, Medicaid will no longer pay for these services from a non-Medicaid provider.

However, IHCP has set up a special enrollment type that will allow you to be in the Medicaid system – but not officially enrolled in Medicaid. It’s called an Ordering, Prescribing or Referring Provider (OPR). If you are already enrolled as another type of provider in Indiana Medicaid, you do not need to enroll as an OPR provider.

If you are not otherwise enrolled as a Medicaid provider, enroll as OPR provider if you:

  • Occasionally see an individual who is an IHCP member who needs additional services or supplies
  • Do not want to be enrolled as another IHCP provider type
  • Do not plan to submit claims to the IHCP for payment of services rendered.

An OPR provider enrollment packet is posted on the Provider Enrollment pages at indianamedicaid.com. The OPR packet asks for minimal information from providers who only order, prescribe and refer IHCP members for services or supplies.

Note that if you treat a patient referred to you by a physician who is not a Medicaid provider and not an OPR provider, you will not be paid for services rendered to the referred patient.

Find information about the change on the Medicaid website here.

Copyright: Information written and displayed on www.ismanet.org is the property of ISMA and may not be reproduced without expressed written permission of the Indiana State Medical Association.

For a more detailed sitemap click here.