Select Health is aligning with Utah Medicaid as the state moves into full compliance with the 21st Century Cures Act. Under this federal requirement, all Ordering, Referring, and Prescribing (ORP) providers must be enrolled with Medicaid, and certain claim types must include the ordering/referring provider’s NPI. These claim types include:
- Home Health
- Durable Medical Equipment (DME)
- Hospice
- Lab
- X-ray
If the ordering/referring provider is not included and/or is not enrolled with Medicaid, the claim will be denied. Denials may occur for claims previously paid that are missing this information, as well as for new claims going forward. To help prevent billing delays, providers should:
- Confirm that all ordering/referring providers are actively enrolled with Utah Medicaid.
- Ensure that claims include the correct provider NPI.
- Contact Utah Medicaid if retro-enrollment is needed.
Questions? Contact your Provider Relations representative for assistance.
More Information:
23-70, Medicaid Information Bulletin, September 2023. Utah Department of Health & Human Services.