Exemption from Ordering/Referring Provider NPI Requirement

On 12/13/2013 an ADvantage Administration Update was sent with the following information:

Per bulletin OHCA 2013-44 from the Oklahoma Health Care Authority (OHCA), some provider types will now be required to provide the National Provider Identifier (NPI) of the ordering/referring physician when submitting claims for reimbursement. This requirement is set to go into effect on January 1, 2014.

It appeared at that time that DME provider agencies would be impacted by this new requirement.

Notification has now been received from the OHCA that the requirement for the NPI of the ordering physician is being exempted for waiver Members. OHCA is updating their claims processing system to bypass the NPI requirement if the Member is in a waiver program and waiver services are being billed.

In essence, this means there will be no change in the process of providing certain DME items to ADvantage Members without a physician’s prescription (such as bathroom equipment and incontinence supplies) provided the items are furnished under a written plan of care and authorized by ADvantage Administration.

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at: aauproviderquestion@aau.okdhs.org

Thank you.