Abbreviated Application for Ordering, Prescribing and Referring Practitioners

As announced over the last several months in the Medicaid Bulletin, effective October 29, 2017, a new abbreviated enrollment application will be available for ordering, prescribing, and/or referring (OPR) practitioners, as an alternative to full enrollment. As required by 42 CFR 455.410, physician and non-physician practitioners who solely order, refer, or prescribe items for NC Medicaid or NC Health Choice (NCHC) beneficiaries must enroll in the Medicaid program.

Physician and non-physician practitioners may elect to enroll as OPR-only providers (OPR lite) for North Carolina Medicaid and NC Health Choice (NCHC) programs. Billing providers will use the NPI (National Provider Identifier) of the OPR lite provider on their claims when these providers order or refer items or services for recipients. OPR lite providers do not and should not submit claims to NC Medicaid or NCHC. NCTracks will not reimburse OPR lite providers when their NPI is used as rendering or attending on a claim.

Starting November 1, 2017, Residents and Interns licensed through the NC Medical Board with a resident in training license (RTL) will also be able to enroll as OPR lite providers via the abbreviated application. These practitioners will use the taxonomy 390200000X, Student Health Care, when enrolling as an OPR lite provider.

The services of the resident or intern are not billable to Medicaid in the teaching setting. Therefore, residents and interns who order services, prescribe medications or services, or make referrals MUST provide their NPI (if appropriate) or their supervising physician's NPI to the provider submitting claims for reimbursement of these services.   The supervising physician may bill for the services that they personally provided during the patient encounter.

Note: The use of the NPI exemption list for residents and interns will cease on January 31, 2018. The exemption from the provider enrollment requirement does not include an exemption from the DEA registration required for controlled substances.

The following enrollment requirements will apply to OPR lite providers:

  • Revalidate every five years
  • $100 application fee
  • Credentialing and background checks, including fingerprinting, if applicable
  • Manage Change Request (MCR) submission to update or end date the provider record

Note: OPR lite providers may request a retroactive effective date up to 365 days before the application date.  An OPR lite provider can submit an MCR to change to a fully enrolled provider if they want to be reimbursed for claims.

Out-of-state and border providers are subject to the fingerprinting requirement. They may have the process completed in their home state and results stored in PECOS or verified through the home state's Medicaid agency. If the organization owner is out-of-state, that owner would be required to fingerprint in the owner's home state and send the evidence to North Carolina Medicaid.

A new instructor-led training course for OPR lite enrollment will be offered beginning November 2017. An announcement will be posted on the Provider Training page of the NCTracks provider portal when the course has been scheduled.