Ordering/Prescribing/Referring/Attending (OPRA) Edits Effective January 1, 2014

Carl J. Pucci in Finance & Reimbursement

 

Medicaid is implementing new claims editing that will require any prescribing professional (including MDS, nurse practitioners and physician’s assistants) to be enrolled as a Medicaid provider in order to be reimbursed under the fee for services (FFS) program.  The new claim edits are effective January 1, 2014.

Attached is a DOH directive which provides additional links, including provider enrollment forms, FAQ’s and EMEDNY LISTSERV updates.  DOH reminds providers to ensure that all necessary prescribers are enrolled in the Medicaid program (including those who prescribe for nursing home residents) to avoid potential interruption of services to their Medicaid FFS recipients.

DOH expects to issue a special edition “Medicaid Update” next week on this topic.

  NYSHFA CONTACT:

Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36