Audience-
Early Intervention (EI) Speech Language Pathologists
Dear Speech Language Pathologist:
This communication is in response to requests for clarification regarding
enrollment in Medicaid as an OPRA provider.
What is this requirement?
Effective January 1, 2014, Medicaid will implement new claim edits requiring
Medicaid enrollment for ordering/prescribing/referring/attending (OPRA)
physicians and other healthcare professionals. If the ordering professional is
not enrolled, under law Medicaid must deny the claim for the ordered service.
Who can issue a recommendation for an EI
speech service?
Orders (otherwise known as a script) for EI speech services may be written by a
physician, nurse practitioner, or physician assistant. Speech Language
Pathology is a profession which can issue a recommendation for their own
service.
EI speech language pathologists should enroll
in Medicaid, correct?
Yes, you are correct.
I am already
actively enrolled in Medicaid. Do I need to enroll as OPRA, too?
Speech pathologists already actively enrolled as practitioners do not need to
enroll as OPRA as well. However, speech pathologists who are only enrolled as
an early intervention provider do need to enroll as OPRA. If you are unsure of
your Medicaid enrollment status, please check here: https://www.emedny.org/info/opra.aspx,
or call CSC at (800) 343-9000.
Why do I need to enroll in OPRA as a
practitioner, when I already enrolled as an EI provider?
Providers enrolled as EI (only) will not appear
on the web search feature because EI providers are not viewed as "practitioners"
they are viewed by Medicaid as "institutions". The web search
doesn't include institutions; If your name does not appear in the enrolled
practitioners search, and you have not submitted an OPRA enrollment form then
you should complete your enrollment as an OPRA provider.
Is there a fee to enroll in Medicaid as an
OPRA professional?
No. Fees do not apply when a professional enrolls as an OPRA professional.
How do I enroll as ordering/referring?
Visit the eMedNY website at: https://www.emedny.org/info/ProviderEnrollment/index.aspx
and click on your provider type’s Provider Enrollment page for the OPRA form.
Be sure to complete all required fields, answer all questions and provide all
required documentation. For assistance with enrollment application questions,
contact CSC at (800) 343-9000.
Can the Medicaid enrollment be back dated?
OPRA applications received from January 1, 2014 through March 31, 2014 will
receive a January 1, 2014 effective date.
If my OPRA enrollment request is approved,
will I be notified?
Yes. Approved applicants will receive an acceptance letter from the Medicaid
program.
As an approved OPRA provider, will my contact
information be made public after I enroll?
Your name, license number and NPI will be on the Search feature on the eMedNY
website so that servicing providers will know you are eligible to order/refer.
If I am approved as an OPRA provider and need
to make changes to my enrollment file, what do I do?
Providers should visit the Provider Enrollment
and Maintenance pages at www.eMedNY.org for
information on how to update their enrollment file. For further information,
please call Computer Sciences Corporation at (800)343-9000, Monday through
Friday, 7:30 a.m. to 6 p.m.
If new information is issued about the
implementation of the ordering/referring requirement, how can I make sure I am
aware of it?
New information will be posted at eMedNY.org, included in Medicaid Updates and
shared through the eMedNY LISTSERV®. If you do not already subscribe to the
eMedNY LISTSERV®, you may enroll at: https://www.emedny.org/Listserv/eMedNY_Email_Alert_System.aspx