On March 17th, the Department of Health Care Services (DHCS) issued a reminder to providers regarding the Center for Medicare & Medicaid Services (CMS) mandate that providers that bill for goods and/or services are required to list the National Provider Identifier of the provider who ordered, referred or prescribed (ORP) the goods or services for a Medi-Cal patient. Under this new mandate, the ORP provider must be enrolled as a participating provider in Medi-Cal, even if that ORP provider does not send claims directly to Medi-Cal for the goods or services they furnish. If the Medi-Cal claim is not accompanied by an ORP NPI upon enforcement, the claim may be denied.

DHCS plans to begin enforcing this mandate using a phased approach but has not yet released information about the enforcement timeline. However, DHCS is urging Medi-Cal providers to work now with their unenrolled providers to submit a provider enrollment application through the Department of Health Care Services’ (DHCS’) Provider Application and Validation for Enrollment portal to enroll with their Type 1 (Individual) NPI. Providers and billers can check the Profile of Enrolled Medi-Cal Fee-for-Service (FFS) Providers web page on the California Health and Human Services Open Data Portal website to verify enrollment.