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Additional information on the Medicaid requirement for a professional to be enrolled as an OPRA

Audience- Early Intervention (EI) Speech Language Pathologists

Dear Speech Language Pathologist: 

This communication is in response to requests for clarification regarding enrollment in Medicaid as an OPRA provider. 

What is this requirement?
Effective January 1, 2014, Medicaid will implement new claim edits requiring Medicaid enrollment for ordering/prescribing/referring/attending (OPRA) physicians and other healthcare professionals. If the ordering professional is not enrolled, under law Medicaid must deny the claim for the ordered service.

Who can issue a recommendation for an EI speech service?
Orders (otherwise known as a script) for EI speech services may be written by a physician, nurse practitioner, or physician assistant. Speech Language Pathology is a profession which can issue a recommendation for their own service.

EI speech language pathologists should enroll in Medicaid, correct?
Yes, you are correct.

I am already actively enrolled in Medicaid. Do I need to enroll as OPRA, too?
Speech pathologists already actively enrolled as practitioners do not need to enroll as OPRA as well. However, speech pathologists who are only enrolled as an early intervention provider do need to enroll as OPRA. If you are unsure of your Medicaid enrollment status, please check here: https://www.emedny.org/info/opra.aspx, or call CSC at (800) 343-9000.

Why do I need to enroll in OPRA as a practitioner, when I already enrolled as an EI provider?
Providers enrolled as EI (only) will not appear on the web search feature because EI providers are not viewed as "practitioners" they are viewed by Medicaid as "institutions".  The web search doesn't include institutions; If your name does not appear in the enrolled practitioners search, and you have not submitted an OPRA enrollment form then you should complete your enrollment as an OPRA provider.

Is there a fee to enroll in Medicaid as an OPRA professional?
No. Fees do not apply when a professional enrolls as an OPRA professional.

How do I enroll as ordering/referring?
Visit the eMedNY website at: https://www.emedny.org/info/ProviderEnrollment/index.aspx
and click on your provider type’s Provider Enrollment page for the OPRA form. Be sure to complete all required fields, answer all questions and provide all required documentation. For assistance with enrollment application questions, contact CSC at (800) 343-9000.

Can the Medicaid enrollment be back dated?
OPRA applications received from January 1, 2014 through March 31, 2014 will receive a January 1, 2014 effective date.

If my OPRA enrollment request is approved, will I be notified?
Yes. Approved applicants will receive an acceptance letter from the Medicaid program.

As an approved OPRA provider, will my contact information be made public after I enroll?
Your name, license number and NPI will be on the Search feature on the eMedNY website so that servicing providers will know you are eligible to order/refer.

If I am approved as an OPRA provider and need to make changes to my enrollment file, what do I do?
Providers should visit the Provider Enrollment and Maintenance pages at www.eMedNY.org for information on how to update their enrollment file. For further information, please call Computer Sciences Corporation at (800)343-9000, Monday through Friday, 7:30 a.m. to 6 p.m.

If new information is issued about the implementation of the ordering/referring requirement, how can I make sure I am aware of it?
New information will be posted at eMedNY.org, included in Medicaid Updates and shared through the eMedNY LISTSERV®. If you do not already subscribe to the eMedNY LISTSERV®, you may enroll at: https://www.emedny.org/Listserv/eMedNY_Email_Alert_System.aspx




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Article ID: 138, Created On: 1/29/2014, Modified: 10/27/2015

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