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Anthem BCBSMedicaid · Administrative · Provider Bulletin · OHHigh impact

[Ohio] Office hours: new ordering, rendering, and prescribing (ORP) provider requirements

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
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.

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What to do

by Dec 31, 2026 · 8 steps
01Billing 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.
02Update billing software to capture and validate ordering/referring/prescribing provider NPI before claim submission.
03Audit current claim templates and provider data to ensure all ORP providers are actively enrolled with valid NPIs.
04Configure system to prevent claim submission with missing or invalid ORP NPI.
05Communicate requirements to all ordering, referring, and prescribing providers to ensure enrollment status is current.
06After January 1, 2027, all claims with ORP NPI errors will be rejected by managed care entities, resulting in claim denials and delayed reimbursement.
07Contact Anthem or Ohio Department of Medicaid for provider enrollment verification.
08Attend available office hours (October 13, October 23, November 16, 2026) for detailed technical guidance.

Original notice

[Ohio] Office hours: new ordering, rendering, and prescribing (ORP) provider requirements
providernews.anthem.com · Always check the source before changing claims.
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