IMPORTANT: Medicaid pharmacy claims written by non‐enrolled prescribers will be denied at point‐of‐sale starting April 1!
Please read this important information from the Ohio Department of Medicaid if you submit pharmacy claims to Ohio Medicaid’s Fee‐For‐Service plan!
Dear Ohio Medicaid Pharmacy Providers,
On April 1, 2015, the Ohio Department of Medicaid will begin to deny claims for prescriptions written by prescribers not currently enrolled with Ohio Medicaid.
These denied claims could cause serious consequences for your patients.
Pharmacy claims for non-enrolled prescribers have been paying, but also triggering this point-of-sale edit since September 2014:
NCPDP Reject Code 56: NON-MATCHED PRESCRIBER IDENTIFIER
With additional message: PRESCRIBER NOT ENROLLED ON DATE RX WRITTEN
Beginning April 1, the same message will post on denied claims when following parameters will apply:
a) Pharmacy claims submitted on or after 4/1/15, for prescriptions written prior to 4/1/15, will require the prescriber to be enrolled as a Medicaid provider on the date dispensed by the pharmacy.
b) Pharmacy claims submitted on or after 4/1/15, for prescriptions written on or after 4/1/15, will require the prescriber to be enrolled as a Medicaid provider both on the date the prescription was written and on the date the prescription is dispensed by the pharmacy.
If you see this edit, it means the prescriber is not enrolled with Ohio Medicaid.
Please help direct all prescribers to enroll with Ohio Medicaid. The enrollment application can be found at: http://medicaid.ohio.gov/PROVIDERS/EnrollmentandSupport/ProviderEnrollment.aspx
The prescriber should click on ‘Enroll as a New Provider’, and check the box for ‘I need to enroll for the sole purpose of Ordering, Referring, or Prescribing (ORP Provider)’ if they choose option b below.
Prescribers may elect to bill as one of two types of providers:
a) ACTIVELY BILLING PROVIDER, meaning that they can bill Medicaid for office visits or other medical services; or
b) ORDERING, REFERRING OR PRESCRIBING (ORP) provider. An “ORP provider” is one who orders, but does not bill for, services to Medicaid enrollees. Examples of ORP providers are medical residents or employees of a hospital or other institution/group practice that bills Medicaid under the institution or group’s NPI.
Questions? Please call the Ohio Medicaid Provider Call Center at 1-800-686-1516.