Provider Alerts

Effective September 27, 2025, Department of Health Care Services (DHCS) removed the web page for Ordering, Referring and Prescribing (ORP) and the Frequently Asked Questions on the Medi-Cal Providers website, which includes the Enrollment Validation Lookup tool.

Per Center for Medicare and Medicaid Services (CMS) mandate, providers that bill for goods or services ordered or referred by another provider are required to list the National Provider Identifier (NPI) of the provider who ordered, referred or prescribed the goods or services being billed on the Medi-Cal claim. The ordering or referring provider must be enrolled as a participating provider in Medi-Cal using their Type 1 NPI even if the provider does not send claims directly to Medi-Cal for the services they furnish.

Health Plan already requires ORP providers to be Medi-Cal enrolled and in situations where an ordering or referring ID is required, billing providers must ensure that the ordering or referring NPI provided on the claim is an active Medi-Cal provider. If the ORP ID on the claim does not meet the criteria, the claim will be denied.

Because the lookup tool is no longer available on the Medi-Cal Provider website, providers must now use the CalHHS Open Data Portal to verify ORP enrollment. https://data.chhs.ca.gov/dataset/profile-of-enrolled-medi-cal-fee-for-service-ffs-providers

For more information, visit the DHCS Medi-Cal Provider website at
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33667

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org