An ORP (Ordering, Referring, or Prescribing provider) is a licensed practitioner who:

• Orders services (i.e., counseling).

• Refers a client to another qualified provider.

• Prescribes treatment or interventions.

• An ORP is required if an unlicensed practitioner is rendering the service and the claim is submitted to Medi-Cal.

• An ORP is not required if a registered associate is providing the service under the supervision of a licensed practitioner.

Below is a chart to help you determine whether an ORP must be enrolled and listed on claims:

Under the Children and Youth Behavioral Health Initiative (CYBHI) Fee Schedule, unlicensed practitioners (PPS School Counselors, PPS School Psychologists, Certified Wellness Coaches, and Certified Health Workers) can provide covered behavioral health services.

• To be reimbursed for these services, there must be a licensed ORP who authorizes or supervises the care.

• The ORP’s National Provider Identifier (NPI) must be included on the Medi-Cal claim

In other words:

• The Servicing Provider is the person who performs the service.

• The ORP is the licensed professional who authorized it, referred to as the rendering provider.

• Both roles are required for compliant billing.

PAVE is the DHCS system used to enroll providers in Medi-Cal.

• Enrollment validates the clinician’s credentials and authorizes their NPI to be used for claims.

• If you will be listed as an ORP for unlicensed staff, you must enroll in PAVE.

• A provider who holds a credential that has a PAVE enrollment pathway must enroll in PAVE. Please see the DHCS Provider Enrollment Options to see if your credential type has an eligible pathway.

• Claims requiring an ORP without an active PAVE enrollment will be denied.

We’ve prepared a step-by-step guide to walk you through the entire PAVE enrollment process.

If you have any questions, please let us know. Thank you!