Ordering, Prescribing, or Referring Providers

For the Indiana Health Coverage Programs (IHCP) to reimburse for services or medical supplies resulting from a practitioner's order, prescription, or referral, the ordering, prescribing, or referring (OPR) provider must be enrolled in Medicaid. A provider may enroll in the IHCP as an OPR-only provider and as such, would not bill the IHCP for services rendered but may order, prescribe, or refer services and supplies for IHCP members. Enrolling as an "OPR-only" provider is appropriate for providers who:

  • May occasionally see an individual who is an IHCP member who needs additional services or supplies that will be covered by the Medicaid program
  • Do not want to be enrolled as another IHCP provider type
  • Do not plan to submit claims to the IHCP for payment of services rendered

OPR Provider verification

IHCP providers that render services must verify IHCP enrollment of the ordering, prescribing, or referring provider before services or supplies are rendered. The OPR Search Tool is a comprehensive search tool that includes OPR-only and other IHCP providers. Providers rendering services should access this tool to make the necessary verification.

Participating as an OPR Provider

A simplified OPR application process requires minimal information and time, and makes participation easy for providers interested in enrolling with the IHCP as OPR-only providers.

  • Before enrolling, please note the following:
    • You must have a National Provider Identifier (NPI). The NPI is the standard, unique health identifier for healthcare providers and is assigned by the National Plan and Provider Enumeration System (NPPES). Applying for the NPI is a process separate from IHCP enrollment. To obtain an NPI, apply online at NPPES.cms.hhs.gov.
    • OPR providers are not required to pay application fees.
    • Opioid treatment centers that do not intend to submit claims for reimbursement should enroll as OPR providers.
    • Providers already enrolled in the IHCP under another provider classification do not need to enroll as OPR providers.
    • OPR providers cannot submit claims to the IHCP for payment for services rendered. To be able to submit claims, you must enroll as a billing, group, or rendering provider. See Complete an IHCP Enrollment Application on this website.
  • Providers are encouraged to enroll as OPR providers using the IHCP Provider Healthcare Portal (Portal). The Portal guides users through the process, and supporting documentation can be attached and submitted online.
  • If you choose to use paper, you must complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. The IHCP provider packet is an interactive PDF file, allowing you to type information into the fields electronically, save the completed file to your computer, and print the file for mailing.
  • After they are enrolled, OPR providers are encouraged to register a Provider Account on the IHCP Portal. The Portal offers a quick and easy way to keep the OPR enrollment information up-to-date. For more information about registering on the Portal, see the Provider Healthcare Portal provider reference module.

Keeping Your OPR Provider Profile up-to-date

The information that identifies and describes a specific provider is called a Provider Profile.

  • Updating Your Profile: When your information changes (for example, changes to license information, contact information, name or address, or the disclosed individuals for organizations), you are required to submit a profile update to the IHCP within 10 business days.
  • Recertifying Your Enrollment: OPR providers must maintain an active license and/or certification to remain enrolled in the IHCP. Providers are not required to submit documentation to recertify their enrollment; the IHCP verifies licensing information periodically.
  • Revalidating Your Enrollment: The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate OPR provider enrollments at intervals not to exceed every five years.
  • Disenrolling: OPR providers may voluntarily disenroll from the IHCP at any time. Providers can disenroll using the Portal, or they can complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Complete only the necessary fields and submit the packet using the mailing instructions at the bottom of this page. After disenrolling as an OPR provider, you may enroll under another provider classification. For more information about enrolling as another provider classification, see Complete an IHCP Enrollment Application.

Processing OPR Provider Transactions

Please allow at least 15 business days for processing before checking the status of your submission. After your transaction is processed, the IHCP Provider Enrollment Unit will notify you of the results.

  • If the submission needs correcting or is missing required documentation, the Provider Enrollment Unit will contact you by telephone, email, fax, or mail. This contact is intended to communicate what needs to be corrected, completed, and submitted before the IHCP can process your enrollment transaction.
    • If your transaction was submitted via the Portal and is rejected for missing or incomplete information, the submission must be corrected in the Portal.
    • If your transaction was submitted via paper, a letter will be sent indicating what needs to be corrected or attached. When submitting the correction or missing information, providers MUST return the entire packet, along with a copy of the letter explaining the errors or omissions as a cover sheet.
  • If your submission is complete, your transaction will be processed.
  • When enrolling, if the IHCP confirms your enrollment, you will receive a verification letter from the Provider Enrollment Unit. If the IHCP denies your enrollment, you will receive a notification letter explaining the denial reason. If you believe your enrollment was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.