Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

region/plan-specific news : Pennsylvania HealthChoices

Ensure you are compliant with the Ordering/Referring/Prescribing (ORP) claims requirement

The Ordering, Referring, and Prescribing requirement was effective for all claims submitted Jan. 1, 2018 and after. Communications and technical assistance have been provided throughout the year to ensure that we have the highest level of compliance.

What you need to do:

  1. Visit the Magellan of PA website for all information related to this important initiative.
  2. Review all documents with your billing teams to ensure that your agency is compliant.
  3. Maintain policies and procedures for employees or referring entities that are actively MA enrolled.
  4. Contact Magellan if you have any questions related to this initiative.

Although we are not currently editing claims based on submission of ORP, this may change early in 2019 depending on state recommendations. It is imperative that all your claims include this information to prevent future claims denials.

Questions?

Contact us at PAHCPQuestions@MagellanHealth.com.

2018 MarCom Gold Award Winner 2017 MarCom Gold Award Winner
2016 MarCom Gold Award Winner 2015 MarCom Platinum Award Winner

About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

Previous Issues