Important Notice: Maryland Medicaid will deny all pharmacy claims at the point-of-sale if the prescribing practitioner is not an actively enrolled Maryland Medicaid provider.
It is imperative that any unenrolled prescribing practitioner enroll as soon as possible to ensure that patients can receive their Medicaid covered medication. Failure to enroll in Maryland Medicaid while rendering care to Medicaid participants risks patient safety and may require a patient to seek care from a different practitioner.
To enroll, apply through Maryland Medicaid's electronic Provider Revalidation and Enrollment Portal (ePREP). For more information, see ePREP Instructions and Training. For more information, see the Prescribing Practitioners section on this page.
Ordering, Referring, and Prescribing (ORP) providers must comply with federal and state rules, regulations and laws regarding enrollment and billing to receive payment for services. Learn more about and find compliance information for your provider type.
Federal regulations require Medicaid to enroll an ORP practitioner as a participating provider for services billable to the Medicaid program. Certain provider types must bill with an ORP practitioner listed on the claim. If a claim includes an ORP provider, the provider must be an active and enrolled individual practitioner in the Medicaid program, see 42 CFR § 455.410. The ORP enrollment requirement includes attending physicians supervising care in institutional settings, including hospitals, nursing facilities and residential treatment centers. For such services, the attending physician serves as the ORP practitioner and must be an active and enrolled Medicaid provider for the facility to receive Medicaid reimbursement.
The Medicaid Provider Verification System (PVS) enables providers who bill ordered or referred services, for example labs, diagnostic, or DME/DMS providers, to determine whether the ORP practitioner is an actively enrolled individual provider on the date of service prior to them rendering the service to a Medicaid participant.
To enroll, apply through Maryland Medicaid’s electronic Provider Revalidation and Enrollment Portal (ePREP). For more information, see ePREP Instructions and Training.
