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Medicaid Ordering, Referring and Prescribing (ORP) Providers Update
Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jun 18, 2026
Summary
Starting July 1, 2026, South Carolina Medicaid will reject claims that don't include the National Provider Identifier (NPI) of physicians who ordered or referred services. All providers who order, refer, or prescribe services for Medicaid members must enroll with SCDHHS as ORP providers, even if they don't submit claims directly.
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What to do
by Jul 1, 2026 · 5 steps
01All providers who order or refer services for South Carolina Medicaid patients must enroll as ORP providers at the SCDHHS enrollment website.
02Billing team must ensure all claims include the ordering/referring physician's NPI.
03Medical residents and interns must use the 'Ordering/Referring' enrollment type specifically.
04Register for virtual training sessions available May-July 2026 at www.medicaidelearning.com or call (888) 289-0709.
05Claims without proper ORP provider information will be rejected and denied payment.
Original notice
Medicaid Ordering, Referring and Prescribing (ORP) Providers Update
scdhhs.gov · Always check the source before changing claims.
Related changes
See all SC Medicaid - SCDHHS changes →Medicaid Ordering, Referring and Prescribing Providers: Pharmacy UpdateHighEffective Dec 1, 2026 · PharmacyMedicaid Enrollment of Ordering, Referring and Prescribing (ORP) Providers and Collection of ORP DataHighEffective Jul 2, 2025 · EnrollmentBrowse every SC Medicaid - SCDHHS change in the policy list