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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 that:

  • 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.
    • A healthcare practitioner enrolling as an OPR provider must enroll using a Type 1 NPI.
    • A business entity enrolling as an OPR provider must enroll using a Type 2 NPI.
  • 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 Provider Enrollment Application on this website.

Providers are encouraged to enroll as OPR providers using the IHCP Provider Healthcare Portal (IHCP Portal). The IHCP 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 enrolling in the IHCP, 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 IHCP 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.
  • Converting Your Enrollment from a Rendering Enrollment to an OPR: When you convert an existing rendering enrollment to an OPR enrollment, you will need to apply for the conversion online through the IHCP Portal or complete and submit the OPR provider enrollment packet. Converting the enrollment classification allows the start and end dates to be effective simultaneously, with no enrollment gap for the provider.
  • Disenrolling: OPR providers may voluntarily disenroll from the IHCP at any time. OPR providers can disenroll using the IHCP 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 Provider Enrollment Application.

Note: Providers wishing to convert their enrollment classification from OPR to rendering do not need to disenroll and then reenroll as two separate steps. Both the portal and the rendering provider enrollment packet allow the OPR to rendering conversion to be performed as a single process with simultaneous start and end dates.

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 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 you are enrolling via the IHCP Portal and your submission is rejected for missing or incomplete information, the submission must be corrected in the portal. Providers will have 21 days to make corrections, or the application will expire.
    • If you are enrolling via paper, a letter will be sent indicating what needs to be corrected or attached. Providers must attach a copy of this letter as a cover sheet when they submit the missing or corrected pages.
  • If the submission is complete, the Provider Enrollment Unit will process your transaction and conduct the appropriate screening associated with your assigned risk level.
  • If the IHCP approves your enrollment or revalidation, you will receive a verification letter from the Provider Enrollment Unit.
  • If the IHCP denies your enrollment or revalidation, you will receive a notification letter explaining the denial reason. If you believe your enrollment or revalidation was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.

Note: Letters from the IHCP Provider Enrollment Unit are sent in envelopes that display the Indiana Family and Social Services (FSSA) logo and the words "Office of Medicaid Policy & Planning" above the return address.

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