In accordance with 13 CSR 65-2 and 42 CFR 455.410, additional screening of MO HealthNet providers is required to improve the integrity of the MO HealthNet Program and to reduce fraud, waste, and abuse. All ordering, prescribing, or referring (OPR) health care professionals are required to enroll with the MO HealthNet Division (MHD), regardless of whether they accept MO HealthNet payment. Claims linked to an order, prescription, or referral will be denied if the OPR provider is not actively enrolled with MHD.
Providers already actively enrolled with MHD do not need a separate OPR enrollment. An ‘OPR only’ designation permits ordering and referring rights only; to bill for rendered services, you must apply as a billing or performing provider. Use the links below to access the OPR provider application.
Providers must submit all three of the documents below. Failure to submit all listed documents will result in an automatic rejection.
Durable Medical Equipment & Laboratory Claims
The Mo Healthnet Remittance Advice (RA) for Durable Medical Equipment (DME) and Laboratory medical claims contains the N613 alert when the ordering provider on the claim is not an active enrolled MO HealthNet provider. The N613 alert indicates that although the claim was paid, the provider has billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid.