UHC Ohio Medicaid: New ORP Claim Denial Policy Announced

Ohio established a new claims submission policy starting May 1, 2025, that mandates all Ordering Referring and Prescribing (ORP) health care professionals to possess a valid National Provider Identifier (NPI). UnitedHealthcare Community Plan of Ohio has stated that they will deny claims that lack an NPI number for ordering, referring, and prescribing professionals as per the new state policy.

The updated requirement supports state initiatives to improve Medicaid billing transparency by requiring NPI numbers. The Y42 denial code accompanies claims that do not fulfill this requirement through one of the following messages.

• OH Ordering NPI Not Submitted on Claim (behavioral health)
• OH Ordering or Referring NPI Not Submitted on Claim

Any health care provider receiving a Y42 denial should correct their claim with the correct NPI number. Make sure it is a timely filing deadline specified in their UnitedHealthcare Provider Agreement. The denial will become permanent when claims are submitted past their deadline.

This policy change will mostly impact behavioral health services, together with other Medicaid-covered treatments that need ORP professional intervention.

Healthcare providers should access UnitedHealthcare’s documentation on claim correction guidelines and view the procedures requiring NPI numbers for ORP professionals. Further information and guidance for UnitedHealthcare services exist under the “Contact Us” section of their website.

Health care professionals, together with billing administrators, must take immediate action to validate that their systems and teams comply with the upcoming May 1 deadline.

Additional details, together with current information, can be found on UHC provider resources available at uhcprovider.com.