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 has updated Order, Prescribe and Refer (OPR) provider requirements. Claims billed with an OPR provider number for services rendered independently will be denied, and specific billing requirements now apply based on provider type and procedure codes.
Action Required
Immediately: Billing team must verify all OPR provider NPIs are valid and active in the 7400 file and registered as OPR type. Ensure OPR providers are NOT listed as rendering physicians. Verify different physicians are listed for rendering vs ordering/referring on claims. Update billing system to require referring/attending NPIs for specified provider types and procedure codes per the detailed tables. Claims will be denied if OPR requirements are not met.