MedicaidAdministrativeHigh impact
[Ohio] OAC Rule 5160-1-17.9 Ordering, Referring and Prescribing Providers
CareSource·OH·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Jun 13, 2026
Summary
Starting January 1, 2027, all Ohio Medicaid claims must include the Ordering, Referring, or Prescribing (ORP) provider's NPI number or they will be denied. This affects numerous services including DME, imaging, lab work, therapies, consultations, and institutional claims.
Action Required
By January 1, 2027: Billing team must update all claim submission processes to include ORP provider NPI numbers for affected services including DME, imaging, lab, therapy, consultation codes 99242-99255, transportation, and institutional claims. Verify all ORP providers are enrolled in Provider Network Management system. Ensure billing software validates NPI presence before submission. Claims missing required ORP NPIs will be automatically denied by CareSource.