MedicaidAdministrativeHigh impact
[Ohio] Office hours: new ordering, rendering, and prescribing (ORP) provider requirements
Anthem BCBS·OH·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Sep 2, 2026
Summary
Ohio Medicaid is implementing new ordering, rendering, and prescribing (ORP) provider requirements effective January 1, 2027. Beginning that date, all claims for designated services (DME, laboratory, imaging, therapy, home health, hospice, dental, and transportation) must include the NPI of an actively enrolled ORP provider, and managed care entities will reject any pending or new claims with ORP NPI errors. This standardizes ORP processes across Ohio Medicaid managed care and fee-for-service programs.
Action Required
By December 31, 2026: Billing team must implement system changes to require and validate ORP provider NPI on all claims for designated services (DME, laboratory, imaging, therapy, home health, hospice, dental, and transportation services) submitted to Ohio Medicaid managed care plans and Anthem MyCare Ohio. Update billing software to capture and validate ordering/referring/prescribing provider NPI before claim submission. Audit current claim templates and provider data to ensure all ORP providers are actively enrolled with valid NPIs. Configure system to prevent claim submission with missing or invalid ORP NPI. Communicate requirements to all ordering, referring, and prescribing providers to ensure enrollment status is current. After January 1, 2027, all claims with ORP NPI errors will be rejected by managed care entities, resulting in claim denials and delayed reimbursement. Contact Anthem or Ohio Department of Medicaid for provider enrollment verification. Attend available office hours (October 13, October 23, November 16, 2026) for detailed technical guidance.