Ohio Medicaid: Include an NPI to avoid denials and delays

Starting Jan. 1, 2027, federal Ordering, Referring, and Prescribing (ORP) mandates require claims for items and services — identified in the comprehensive list below — to include the National Provider Identifier (NPI) of the health care professional who ordered, referred or prescribed those items or services. Any claims not meeting this ORP requirement will be denied.

The state of Ohio has prepared an implementation plan to ensure consistent application of this requirement across all managed care entities and Ohio’s fee-for-service Medicaid program.

This initiative will result in:

• A single, statewide list of services subject to ORP requirements
• Updated OMES system edits to uniformly enforce ORP requirements on claims and encounters across all Medicaid delivery systems
• Greater consistency in claims processing and compliance with federal Medicaid regulations

The comprehensive list of ORP-designated services is posted on the Ohio Department of Medicaid’s website. 

Providers should review their billing practices to ensure that applicable claims include the appropriate ordering, referring or prescribing provider NPI to minimize claim denials and processing delays.

Any additional guidance will be communicated as implementation activities progress.