Ordering and Referring Requirement

Are you familiar with ordering and referring requirements? Under state law (which was required under the ACA), providers authorized to order, refer, or prescribe must register with MassHealth at least as a nonbilling provider. There’s been a series of bulletins, the most recent of which was posted online today here.

The School-Based Medicaid Program is NOT editing claims based on whether providers have fulfilled this requirement at this time (there are not plans to start doing so either, but I’ll let you know if that changes). However, it is a requirement for licensure under DPH’s licensure boards. So to the extent that NPs and other providers need to be certified and licensed to participate in the SBMP and the licensure board requires it, these providers need to register with MassHealth (again, just to maintain their certification with DPH).