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Ordering/Prescribing/Referring (OPR) Providers Must Revalidate for Claims to be Paid

Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years.  For many providers Medicaid payment is contingent on the ordering/prescribing/referring (OPR) provider also revalidating their enrollment in Medicaid.  OPR providers who do not comply with the revalidation requirement will be terminated from the Medicaid Program.

The NYS Department of Health has determined that many providers are at risk for not being paid for their services because the OPR provider has not complied with the revalidation requirement.  Because this has the potential to result in significant non-payable claims for you/your facility, we urge you to reach out and encourage your OPR providers to revalidate their enrollment.  Please remember to confirm that your OPR provider is enrolled before rendering service at: www.emedny.org/info/opra.aspx.

  • The Claim Adjustment Reason Code for non-enrolled OPR provider on your 835 remittance will be:  B7 – This Provider was Not Certified/Eligible to be Paid For this Procedure/Service on this Date of Service.
  • If performing a claim status look for Claim Status Code 91 with Entity Code 1P.

The required revalidation form and instructions are available at https://www.emedny.org/info/ProviderEnrollment/revalidation/index.aspx.  The completed form must be mailed, with all required documentation and fee (if required), to the address provided on page 2 of the form.  Questions should be addressed to the eMedNY Call Center at 800-343-9000, Option 2.


The NYC Department of Health and Mental Hygiene is conducting a large-scale recruitment for school physicians to work at NYC’s public schools.  The candidates being sought should be licensed physicians (specifically pediatricians, family medicine doctors, adolescent medicine doctors, or preventive medicine doctors) who also have a strong public health/population health background (ideally an MPH in addition to MD), and who would like a rewarding opportunity with flexible hours.  Details on available positions:


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