Frequently Asked Questions FAQs - PDF document

1 Rev. 5 / 2 6 /21 Page 1 Frequent
Rev. 5 / 2 6 /21 Page 1 Frequently Asked Questions (FAQs) Referring, Ordering, Prescribing, Attending (ROPA) Providers Q 1 : What types of providers are affected ? Q 2 : Which Medicaid programs are affected ? Q 3 : Wh at services are affected ? Q 4 : As a rendering/service provider, how can I find out if my ROPA provid er(s) is registered with AHCCCS ? Q 5 : Can a provi der retroactively enroll ? Q 6 : How long d oes the enrollment process take ? Q7 : Does this affect practitioners who ar e actively enrolled in Medicaid ? Q 8 : Are ROPA Providers mandated to acc ept Medicaid patients ? Q 9 : Do atten ding providers need to register ? Q1 0 : Will ROPA providers be required to re - validate their registration ? Q 11 : What if I’m a prescribing provider who is not an AHCCCS registerable provider type (i.e. Pharmacist, Naturopath who treat s adults only, etc.) ? Q 12 : How can I enroll as an ROPA Provide r ? Q 13 : (updated 3/2/21) How should MCOs handle rejects at point - of - sale for pharmacies? Will there be exceptions for lifesaving prescriptions (such as inha lers) and hospital discharges ? Q 14 : I f AHCCCS is the secondary insurance for a member, will all providers on their claim have to comply with the ROPA requi rements by the deadline as well ? Q15: (added 3/22/21) If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? Q1 6 : (added 4 /22/21) How should labs handle the situation when AHCCCS members p resent an order that originated from a non - enrolled AHCCCS provider ? Q 17. (added 5/26/21) If I am already an AHCCCS registered provider, do I need to complete additional ROPA registration? Q 1 : What types of providers are affected ? A 1 : As require d by the federal government, all medical providers (who are a registerable provider type) must be enrolled with th e State Medicaid program in order for Medicaid to pay for services to which they attend, prescribe, order or refer. The rule applies even if the provider does not accept Medicaid payment for th e provider's own services or wishes to otherwise participate as a Medicaid provider. See Medical Policy Manual Chapter 601, Attachment A for a list of regi sterable provider types. Q 2 : Which Medicaid programs are affected ? A 2 : This rule applies to all AHCCCS programs regardless of managed car e or fee - for - service delivery . Q 3 : What services are affected ? A 3 : The provider should enroll before attending, ordering, prescribing, or referring services. The service must continue to be within the provider’s scope of practice to attend, order, prescribe, or refer , and all other program rules for seeking coverage apply. Services affected by this new r ule include, but are not limited to, home care services, lab testing, durable medical equipment, and prescription drugs. Rev. 5 / 2 6 /21 Page 2 EXAMPLE: If an AHCCCS member uses a Medicaid card at the pharmacy counter because she has fee - for - service prescription coverage, Med icaid will not pay for the prescriptions unless the provider who prescribed the drugs is an AHCCCS registered provider or is identified as a non - registerable provider type . Q4: As a rendering/service provider, how can I find out if my ROPA provider is reg istered with AHCCCS ? A 4 : Rendering/service providers reporting a pplicable prescribing, ordering, referring, or attending providers on their claims submissions to all AHCCCS programs must verify that these providers have appropriate registration. If they a re a registerable provider type , u se the online AHCCCS Provider Listing web page to verify enrollment . Q 5 : Can a provider retroactively enroll ? A5 : Yes for all p rovider types listed except the new OR provider type (the new provider type is prescribing or ordering providers that will allow for use as a prescribing/ordering authority only) for which retroactive registration will be effective no earlier than 10/1/2 020. AHCCCS will pay retroactive claims and encounters involving registered, eligible providers subject to timeliness rules. Q 6 : How long d oes the enrollment process take ? A 6 : Provider enrollment applications are typically processed wi thin an average of six (6) business days, but may t ake a maximum of 45 days from the d ate the application is received . Q 7 : Does this affect practitioners who ar e actively enrolled in Medicaid ? A 7 : Providers who are already registered with AHCCCS and are attendin g, prescribing, ordering or referring do not need to re - enroll . Q8 : Are ROPA Providers manda ted to accept Medicaid patients ? A 8 : No. All providers have the choice of whether or not to accept Medicaid patients . Q 9 : Do atten ding providers need to register ? A 9 : Yes, attending providers should be registered if they are a registerable provider type . Q10 : Will ROPA providers be required to re - validate their registration ? A 10 : Yes, all providers, including ROPA providers, must re - validate their AHC CC S enrollment every four (4) years . Q 11 : What if I’m a prescribing provider who is not an AI///S registerable provider type (i.e. tharmacist, Naturopa th who treat s adults only, etc.) ? A 11 : AHCCCS has identified an alternative exception process for prescri bing or ordering providers (who are not registerable provider types) that will allow for participation as a provider with referring, order

2 ing, prescribing, or attending authorit
ing, prescribing, or attending authority only. Q12: How c an I enroll as an ROPA Provider ? A12 : P roviders who : • do not want to bill Medicaid for covered services , and • only want to prescribe, order, attend, or make referrals for Medicaid reci pients, and • are a registerable provider type can enroll with AHCCCS. New providers can enroll here . Currently enrolled providers can login to AHCCCS Online . Rev. 5 / 2 6 /21 Page 3 Q13: How should MCOs handle rejects at point of sale for ph armacies? Will there be exceptions for lifesaving prescriptions (such as inh alers) and hospital discharges? A13: AHCCCS members are not financially responsible for any out of pocket expenses, with the exception of member copayments, for an emergency servic e or lifesaving prescription that is ordered and or rendered by a non AHCCCS registered provider. The financial responsibility will remain with the Managed Care Organization if the member needs a lifesaving prescription and/or has an emergency. Emergency is defined in 42 C.F.R. 438.114. as a medical service provided for a non - FES member for the treatment of an emergency medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: • tlace the member’s health in serious jeopardy, • Serious impairment to bodily functions, or • Serious dysfunction of any bodily organ or part. Q14: If AHCCCS is the secondary insurance for a member, will all providers on their claim have to comply with the ROPA requirements by the deadline as well? A14: Yes, the requirement applies whether AHCCCS is a memb er’s primary or secondary insurance. Q15: If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? A15: If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? To have missing resident s, interns or pharmacists added to the ROPA excepted Provider List, please email the following information to the address listed below: • NPI, • Provider Name, • Indication of whethe r the NPI is associated with a resident, an i ntern or a pharmacist, + and • B eg inning date associated with this association. Email: ROPAExceptions@azahcccs.gov Q16: How should labs handle the situation when AHCCCS members present an order that originated from a non - enrolled AHCCC S provider? A16: The provider should not accept the order from a non - enrolled AHCCCS provider, as that claim will not be paid. Q17. If I am already an AHCCCS registered provider, do I need to complete additional ROPA registration? A17. No, if you are already an AHCCCS registered provider, you do not need to take any further action to be recognized for ROPA purposes. Rev. /2/21 Page 3 Q13: How should MCOs handle rejects at point of sale for ph armacies? Will there be exceptions for lifesaving prescriptions (such as inh alers) and hospital discharges? A13: AHCCCS members are not financially responsible for any out of pocket expenses, with the exception of member copayments, for an emergency servic e or lifesaving prescription that is ordered and or rendered by a non AHCCCS registered provider. The financial responsibility will remain with the Managed Care Organization if the member needs a lifesaving prescription and/or has an emergency. Emergency is defined in 42 C.F.R. 438.114. as a medical service provided for a non - FES member for the treatment of an emergency medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: tlace the member’s health in serious jeopardy, Serious impairment to bodily functions, or Serious dysfunction of any bodily organ or part. Q14: If AHCCCS is the secondary insurance for a member, will all providers on their claim have to comply with the ROPA requirements by the deadline as well? A14: Yes, the requirement applies whether AHCCCS is a memb er’s primary or secondary insurance. Q15: If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? A15: If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? To have missing resident s, interns or pharmacists added to the ROPA excepted Provider List, please email the following information to the address listed below: NPI, Provider Name, Indication of whethe r the NPI is associated with a resident, an i ntern or a pharmacist, + and B eg inning date associated with this association. Email: ROPAExceptions@azahcccs.gov Q16: A16: Q17. If I am already an AHCCCS registered provider, do I need to complete additional ROPA registration? if you are already an AHCCCS registered provider, you do not need to take any further action to be recognized for ROPA purposes. Rev. 6/21/21 Page 2 EXAMPLE: If an AHCCCS member uses a Medicaid card at the pharmacy counter because she has fee - for - service prescription coverage, Med icaid will not pay for the prescriptions unles

3 s the provider who prescribed the drugs
s the provider who prescribed the drugs is an AHCCCS registered provider or is identified as a non - registerable provider type . Q4: As a rendering/service provider, how can I find out if my ROPA provider is reg istered with AHCCCS ? A 4 : Rendering/service providers reporting a pplicable prescribing, ordering, referring, or attending providers on their claims submissions to all AHCCCS programs must verify that these providers have appropriate registration. If they a re a registerable provider type , u se the online AHCCCS Provider Listing web page to verify enrollment . Q 5 : Can a provider retroactively enroll ? A5 : Yes for all p rovider types listed except the new OR provider type (the new provider type is prescribing or ordering providers that will allow for use as a prescribing/ordering authority only) for which retroactive registration will be effective no earlier than 10/1/2 020. AHCCCS will pay retroactive claims and encounters involving registered, eligible providers subject to timeliness rules. Q 6 : How long d oes the enrollment process take ? A 6 : Provider enrollment applications are typically processed wi thin an average of six (6) business days, but may t ake a maximum of 45 days from the d ate the application is received . Q 7 : Does this affect practitioners who ar e actively enrolled in Medicaid ? A 7 : Providers who are already registered with AHCCCS and are attendin g, prescribing, ordering or referring do not need to re - enroll . Q8 : Are ROPA Providers manda ted to accept Medicaid patients ? A 8 : No. All providers have the choice of whether or not to accept Medicaid patients . Q 9 : Do atten ding providers need to register ? A 9 : Yes, attending providers should be registered if they are a registerable provider type . Q10 : Will ROPA providers be required to re - validate their registration ? A 10 : Yes, all providers, including ROPA providers, must re - validate their AHC CC S enrollment every four (4) years . Q 11 : What if I’m a prescribing provider who is not an AI///S registerable provider type (i.e. tharmacist, Naturopa th who treat s adults only, etc.) ? A 11 : AHCCCS has identified an alternative exception process for prescri bing or ordering providers (who are not registerable provider types) that will allow for participation as a provider with referring, ordering, prescribing, or attending authority only. Q12: How c an I enroll as an ROPA Provider ? A12 : P roviders who : do not want to bill Medicaid for covered services , and only want to prescribe, order, attend, or make referrals for Medicaid reci pients, and are a registerable provider type can enroll with AHCCCS. New providers can enroll here . Currently enrolled providers can login to AHCCCS Online . Rev. 6/21/21 Page 1 Frequently Asked Questions (FAQs) Referring, Ordering, Prescribing, Attending (ROPA) Providers Q 1 : What types of providers are affected ? Q 2 : Which Medicaid programs are affected ? Q 3 : Wh at services are affected ? Q 4 : As a rendering/service provider, how can I find out if my ROPA provid er(s) is registered with AHCCCS ? Q 5 : Can a provi der retroactively enroll ? Q 6 : How long d oes the enrollment process take ? Q7 : Does this affect practitioners who ar e actively enrolled in Medicaid ? Q 8 : Are ROPA Providers mandated to acc ept Medicaid patients ? Q 9 : Do atten ding providers need to register ? Q1 0 : Will ROPA providers be required to re - validate their registration ? Q 11 : What if I’m a prescribing provider who is not an AHCCCS registerable provider type (i.e. Pharmacist, Naturopath who treat s adults only, etc.) ? Q 12 : How can I enroll as an ROPA Provide r ? Q 13 : (updated 3/2/21) How should MCOs handle rejects at point - of - sale for pharmacies? Will there be exceptions for lifesaving prescriptions (such as inha lers) and hospital discharges ? Q 14 : I f AHCCCS is the secondary insurance for a member, will all providers on their claim have to comply with the ROPA requi rements by the deadline as well ? Q15: (added 3/22/21) If I am a resident, intern or pharmacist and I don't see my NPI listed on the ROPA excepted Provider List, how do I get added to the list? Q1(ed /22/21) Q 17. (added 5/26/21) If I am already an AHCCCS registered provider, do I need to complete additional ROPA registration? Q 1 : What types of providers are affected ? A 1 : As require d by the federal government, all medical providers (who are a registerable provider type) must be enrolled with th e State Medicaid program in order for Medicaid to pay for services to which they attend, prescribe, order or refer. The rule applies even if the provider does not accept Medicaid payment for th e provider's own services or wishes to otherwise participate as a Medicaid provider. See Medical Policy Manual Chapter 601, Attachment A for a list of regi sterable provider types. Q 2 : Which Medicaid programs are affected ? A 2 : This rule applies to all AHCCCS programs regardless of managed car e or fee - for - service delivery . Q 3 : What services are affected ? A 3 : The provider should enroll before attending, ordering, prescribing, or referring services. The service must continue to be within the provider’s scope of practice to attend, order, prescribe, or refer , and all other program rules for seeking coverage apply. Services affected by this new r ule include, but are not limited to, home care services, lab testing, durable medical equipment, and prescription drugs.