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Dental Medicaid: Ordering-Prescribing-Referring Providers

On December 21, 2016 a MO HealthNet provider bulletin was published explaining that any provider prescribing medications to a Medicaid patient must be a Medicaid provider or the prescriptions will be denied.

Current state and federal regulations (13 CSR 65-2 and 42 CFR 455.410) require  ordering, prescribing or referring (OPR) providers to enroll with Medicaid, even if they do not accept Medicaid. This is a FEDERAL Medicaid regulation required for ANY PROVIDER prescribing to a Medicaid patient. 

The following alert will trigger when the ordering, prescribing, or referring provider on the claim is not an actively enrolled provider:

Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.

This alert will be sent to the patient outlining the lack of provider enrollment; from this, claims will deny if the prescriber isn’t enrolled in Medicaid AND there are no exceptions.

See the full information online as well as contact information for questions.