Medicaid Ordering, Referring and Prescribing (ORP) Providers Update

As described in the Medicaid bulletin issued July 2, 2025, ( MB# 25-015 ) and consistent with federal law, providers who order, refer or prescribe items or services for South Carolina Healthy Connections Medicaid members must enroll with the South Carolina Department of Health and Human Services (SCDHHS) as Medicaid providers regardless of whether they submit claims for these items or services. In this update, SCDHHS is reminding providers of this requirement, providing resources to ensure providers are compliant and issuing guidance on how medical residents and interns can enroll as an ORP provider.

Ordering and Referring Providers

Effective July 1, 2026, claims submitted by providers who order or refer medical services will begin to reject and payments will not be issued for fee-for-service (FFS) claims that are submitted without federally required ORP provider information . This will impact claims for payment of items or services that were ordered or referred and did not properly include the National Provider Identifier (NPI) of the physician or other professional who ordered or referred the items or services. SCDHHS will provide additional guidance and resources as it pertains to providers who prescribe items or services for Healthy Connections Medicaid members.

Guidance for Enrolling Medical Residents and Interns

Per current SCDHHS policy, medical residents and interns are not eligible to enroll as Healthy Connections Medicaid providers. However, to comply with this federal regulation, these individuals should enroll online via the SCDHHS enrollment website by selecting the "Ordering/Referring" enrollment type. This option has been created specifically for the purpose of enrolling individuals who order, refer or prescribe that would otherwise be ineligible to enroll. This enrollment creates a Healthy Connections Medicaid provider ID that can be used only by individuals who are ORP-only and cannot be used for any individual who intends to render or bill services. The enrollment process for these individuals is an abbreviated version of the full enrollment application, which reduces the overall time needed to enroll.

ORP Provider Training and Resources

SCDHHS' contracted vendor will provide one-hour live virtual training presentations on ORP to address federal requirements. Virtual training dates are listed below and are available on the agency's ORP webpage at www.scdhhs.gov/ORP and the Medicaid E-learning Portal.

Please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709 to register for one of the training presentations.

Training updates will continue to be posted on both the SCDHHS ORP webpage and the Medicaid E-Learning portal.

Providers should direct questions related to this bulletin to PSC. PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative .

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