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Ohio Medicaid: Include ORP NPI to avoid denials
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 1, 2026
Summary
Starting January 1, 2027, Ohio Medicaid claims for designated items and services must include the National Provider Identifier (NPI) of the ordering, referring, or prescribing provider. Claims missing this ORP (Ordering, Referring, and Prescribing) NPI will be denied. Ohio has established a statewide implementation plan with a comprehensive list of affected services posted on the Ohio Department of Medicaid website.
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What to do
by Dec 31, 2026 · 6 steps
01Billing team must identify all ORP-designated services applicable to your practice by reviewing the comprehensive list on the Ohio Department of Medicaid website.
02Update billing software and claim submission processes to capture and validate the ordering/referring/prescribing provider NPI for all affected services.
03Modify encounter forms and provider templates to require providers to document the NPI of the ordering/referring/prescribing professional.
04Conduct staff training on new requirements.
05Beginning January 1, 2027, verify that every claim for ORP-designated services includes the appropriate provider NPI before submission to Ohio Medicaid.
06Claims submitted without the required NPI will be denied and cause processing delays.
Original notice
Ohio Medicaid: Include ORP NPI to avoid denials
uhcprovider.com · Always check the source before changing claims.