Providers submitting claims for laboratory services and durable medical equipment (“DME”) have been receiving an alert on their remittance advices when the Ordering, Prescribing, or Referring (“OPR”) physician is not enrolled and in an active status. Currently those claims are set to pay, but in the future, the claims will not be paid until the OPR physician either enrolls or updates his or her enrollment record.

Soon providers will receive a similar alert for pharmacy claims, imaging claims, and home health claims.  These also require “OPR” physician information.   In the future, these claims will deny as well if the OPR physician is not enrolled.   Claims will continue to pay for a period of time in order to alert providers submitting these claims.

MMAC will give priority to any OPR application we receive in order to help ensure no disruption in services or payment.

Visit mmac.mo.gov to read more about OPR requirements.  Click here.