Maryland Medicaid Enrollment Policy Changes – Effective 10.1.19

May 10, 2019

Maryland Medicaid will implement important physician enrollment policy changes to comply with federal requirements for Ordering, Referring, and Prescribing (ORP) providers. For full details, please refer to this letter, which details the updated policies.

Effective October 1, 2019, the Maryland Department of Health will deny payment for prescriptions from providers who are not actively enrolled with Maryland Medicaid, either as an ORP Provider or as a full billing or rendering Medicaid provider.

Why now? The changes is to comply with Section 6401 of the Affordable Care Act and Code of Federal Regulations section 42 CFR 455.410(b), which prohibits state Medicaid agencies from reimbursing for ordered, referred, or prescribed services when the ORP practitioner is not enrolled in the state Medicaid program.

ORP Provider Enrollment Rules – An individual provider may choose to enroll as either an ORP Provider, or as a fully participating billing or rendering provider. Enrolling as an ORP Provider differs from full Medicaid enrollment in the following ways:

ORP Providers do not sign a Maryland Medicaid Provider Agreement;
ORP Providers may neither submit claims to, nor receive payment from, Maryland Medicaid;
An ORP Provider may not appear on a claim as a rendering provider for professional services billable to Maryland Medicaid.

How to Register as an ORP Provider – Enrollment is hosted through the electronic Provider Revalidation and Enrollment Portal (ePREP). You will be offered an option of “I’m an ORP provider” when starting the application. Here is a guide on how to sign-up. For assistance with ePREP, call 844.463.7768 or email MDPRoviderRelations@automated-health.com. For enrollment policy questions, contact mdh.rxenroll@maryland.gov.

Webinars – Maryland Medicaid will offer web based training sessions to educate users on how to enroll as an ORP provider, and how to maintain a Medicaid account. Here are upcoming webinars, and how to register: