NYSPA Prescribing Update


Prescribing Update

NYS Medicaid has announced that practitioners must now be enrolled in Medicaid to enable them to continue to prescribe medication for Medicaid beneficiaries (dual eligible patients may also be affected).

Pharmacies will be unable to fill prescriptions written for Medicaid beneficiaries if the prescriber is not enrolled in NYS Medicaid FFS (fee for service). This applies to both new prescriptions and refills.

The enrollment requirement applies to all services, including prescription drugs, provided under the Medicaid state plan or under a waiver of the state plan (the Fee For Service Medicaid program). It does not apply to services paid through a Medicaid managed care plan.

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

Ordering professionals who have not yet submitted enrollment applications must do so immediately to avoid future interruption of the services they order for their patients.

OPRA professionals who submit an application between January 1, 2014 and March 31, 2014 will be given an enrollment effective date of January 1, 2014.

Enrolling as an Ordering/Prescribing/Referring/Attending Provider

If you are not currently enrolled in the Medicaid program, you can enroll as an Ordering/Prescribing/Referring/Attending (OPRA) provider by following the instructions on the eMedNY website at https://www.emedny.org/info/ProviderEnrollment/index.aspx#select

Verification of Provider Enrollment

If you are unsure whether you are currently enrolled as a Medicaid provider, you can easily verify your enrollment status on the eMedNY website at https://www.emedny.org/info/opra.aspx

Additional information regarding enrollment as an OPRA provider can be found at:

For more updated FAQs on OPRA requirements, background, enrollment and claims editing, please visit the provider enrollment website.

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