There has been some confusion surrounding Ordering, Prescribing or Referring (OPR) provider information submitted to the NC Medicaid Managed Care Plans for certain claim types.
As a reminder, when applicable, rendering, attending, ordering or referring provider information (including taxonomy information) must be submitted on claims to NC Medicaid Managed Care health plans for primary and secondary claims.
This information is required whether the claim comes from the individual provider, through a clearinghouse or via Medicare Crossover. Please be advised that the Medicare intermediary may not require certain information that NC Medicaid requires. The information will need to be submitted on the Medicare primary claim so that the information will cross over to the NC Medicaid Managed Care health plan.
Durable Medical Equipment providers should remember for consignment closets, your organization is the provider/supplier and you need to submit your claims accordingly. The hospital’s attending provider is the provider that ordered the supply. Also, please remember that affiliation rules apply.
For more information, please refer to the previous bulletin Federal Regulation Guidelines for Ordering, Prescribing or Referring Providers.
Contact
NC Medicaid Managed Care Business Operations Team
Medicaid.ClaimsTA@dhhs.nc.gov