MedicaidAdministrativeHigh impact
[Georgia] 2025 Order, Prescribe and Refer (OPR) Update
CareSource·GA·Provider Bulletin
Effective date
Feb 1, 2025
We identified it
Jun 13, 2026
Summary
Georgia Medicaid requires specific providers to use Order, Prescribe and Refer (OPR) provider numbers correctly. Claims with OPR providers listed as rendering physicians will be rejected, and certain facility types must include referring/attending NPIs for lab, radiology, and consultation services.
Action Required
By February 1, 2025: Billing team must ensure OPR providers are never listed as rendering physicians on claims - use only for ordering/referring. For hospital claims (14x, 71x, 73x, 81x-83x bill types), verify referring/attending NPI is included for all lab (80001-89399), radiology (70002-79999), and consultation (99241-99255) services. Verify all OPR NPIs are active in 7400 file and registered as OPR type. Claims violating these rules will be denied.