How to Enroll to be a MassHealth ORP Provider

MassHealth Services that Require an Order, Referral, or Prescription

The following services and supplies require an order, referral, or prescription from a provider in order for the billing provider to receive MassHealth payment.

• Any service that requires a PCC referral (see MassHealth All Provider Regulations 130 CMR 450.118(J))
• Adult Day Health
• Adult Foster Care
• Continuous Skilled Nursing
• DME
• Eyeglasses
• Group Adult Foster Care
• Home Health
• Independent Nurse
• Labs and Diagnostic Tests
• Medications
• Orthotics
• Oxygen/Respiratory Equipment
• Prosthetics
• Psychological Testing
• Therapy (PT, OT, ST)

Claims for the services listed above that are ordered, referred, or prescribed by a clinician who is not a provider type listed below must include the NPI of the clinician’s supervising physician (or other authorized ORP provider) on the claim. In that situation, the authorized ORP provider must also be enrolled in MassHealth as a fully participating provider or as a nonbilling provider in order for the billing provider’s claim to be payable.

Note: pharmacy claims must include the individual NPI of the actual prescribing provider.

Provider Types Authorized to Order, Refer, or Prescribe

The following types of providers are the only provider types that may be listed on a claim as the ORP provider and are referred to as authorized ORP providers. Interns, residents, and other trainees in the provider types listed below who are authorized to order, refer, or prescribe services are also considered ORP providers

• Certified Nurse Midwife
• Certified Registered Nurse Anesthetist
• Clinical Nurse Specialist
• Dentist
• Licensed Independent Clinical Social Worker
• Certified Nurse Practitioner
• Optometrist
• Pharmacist (if authorized to prescribe)
• Physician
• Physician Assistant
• Podiatrist
• Psychiatric Clinical Nurse Specialist
• Psychologist

Massachusetts state law requires that the types of providers listed above apply for enrollment in MassHealth at least as a nonbilling ORP provider in order to obtain and maintain state licensure. Providers who wish to enroll as nonbilling ORP providers should download the Nonbilling Provider ORP Contract and Application.

Please complete, sign, and return this form and the Nonbilling Provider Contract by mail to the MassHealth Customer Service Center (CSC),  Attn. MassHealth Provider Enrollment, P.O. Box 278, Quincy, MA 02171.

You can address questions about the form- to CSC  at (800) 841-2900 or provider@masshealthquestions.com.

Dentists should submit the form and signed contract by mail to DentaQuest at Masshealth Dental Program, Attn: Provider Enrollment and Credentialing, P.O. Box 2906, Milwaukee, WI 53201-2906

Before you submit your enrollment package, please refer to the MassHealth Administrative and Billing regulations (130 CMR 450.000). All portions of these regulations that are not related to billing and payment apply to nonbilling ORP providers. For providers eligible to be fully participating providers, please also refer to the corresponding MassHealth Provider Regulations.

MassHealth will notify you about its decision regarding your application. You are not a fully participating or nonbilling ORP provider until MassHealth notifies you that your application has been approved.

For more information about the claims impacted by the Ordering and Referring requirements see All Provider Bulletin 286 and 361, available on the All Provider bulletins page.

If you have any questions about the enrollment process, or if you wish to request the materials to enroll with MassHealth as a fully participating provider, please call the MassHealth Customer Service Center (CSC).