Non-Billing, Ordering, Prescribing, and Referring (NOPR) Edits Changing from Warn to Deny – CR 121469

Dec 27, 2023

Billing providers must include the National Provider Identifier (NPI) of an enrolled MaineCare practitioner who is ordering, prescribing, or referring on their claims to receive reimbursement for the categories of services listed below. These practitioners are known as NOPRs and must enroll in MaineCare independently or as part of an organization. 

This requirement is for all prescription claims (including Point of Sale claims) as well as claims for the following: 

• Clinical laboratories for ordered tests 
• Imaging centers for ordered imaging procedures 

• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 

Effective January 1, 2024, claim edits will deny claims if the ordering, prescribing, or referring provider is not actively enrolled as a full MaineCare or NOPR provider. The claims will also be denied if the claim is submitted without the ordering, prescribing, or referring provider NPI.   

We are aware that the adjustment of some claims may not process correctly when this update goes live on January 1, 2024. We are working to correct this issue as soon as possible. We will send an updated message once this issue has been resolved. In the meantime, adjustment claims that denied incorrectly can be resubmitted. Please do not hold claims.      

​​If you have any questions, please contact Provider Services at: 1-866-690-5585.​