Frequently Asked Questions (FAQs) for Referring, Ordering, Prescribing, Attending (ROPA) Providers

Please see Frequently Asked Questions (updated 9/30/2020) about the ROPA requirements.

  • Q1: What types of providers are affected?

    A1: As required by the federal government, all medical providers must be enrolled with the State Medicaidprogram in order for Medicaid to pay for services that they attend, prescribe, order or refer. The rule applies even if the provider does not accept Medicaid payment for the 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 provider types.

  • Q2: Which Medicaid programs are affected?

    A2: This rule applies to all AHCCCS programs regardless of managed care or fee-for-service delivery.

  • Q3: What services are affected?

    A3: The provider should enroll before ordering, prescribing, or referring services. The service must continue to be within the provider’s scope of practice to order, prescribe, or refer and all other program rules for seeking coverage apply. Services affected by this new rule include, but are not limited to, home care services, lab testing, durable medical equipment, and prescription drugs.

    EXAMPLE: If an AHCCCS member uses a Medicaid card at the pharmacy counter because she has fee-for-service prescription coverage, the prescriptions will not be paid for by Medicaid unless the provider who prescribed the drugs is an AHCCCS registered provider.

  • Q4: Can a provider retroactively enroll?

    A4: Yes, AHCCCS will pay retroactive claims and encounters involving registered, eligible providers subject to timeliness rules.

  • Q5: How long does the enrollment process take?

    A5: Provider enrollment applications are typically processed within an average of 6 business days, but may take a maximum of 45 days from the date the application is received.

  • Q6: Does this affect practitioners who are actively enrolled in Medicaid?

    A6: Providers who are already registered with AHCCCS do not need to re-enroll as a ROPA provider.

  • Q7: Are ROPA Providers mandated to accept Medicaid patients?

    A7: No. All providers have the choice of whether or not to accept Medicaid patients.

  • Q8: Do attending providers need to register?

    A8: Yes, attending providers should be registered.

  • Q9: Will ROPA providers be required to re-validate their registration?

    A9: Yes, all providers, including ROPA providers, must re-validate their AHCCCS enrollment every four years.

  • Q10: What if I’m a prescribing provider who is not an AHCCCS registerable provider type (i.e. Pharmacist, Naturopath who treat adults only, etc.)?

    A10: In the future, AHCCCS will establish a new provider type for prescribing or ordering providers that will allow for use as a prescribing authority only.

  • Q11: As a rendering/service provider, how can I find out if my ROPA provider(s) is registered with AHCCCS?

    A11: Rendering/service providers reporting applicable prescribing, ordering/referring, or attending providers on their claims submissions to all AHCCCS programs must verify that these providers have appropriate registration using the online AHCCCS Provider Listing web page.

  • Q12: How can I enroll as an ROPA Provider?

    A12: All providers who do not want to bill Medicaid for covered services, or only want to prescribe, order, attend, or make referrals for Medicaid recipients, can enroll with AHCCCS. New providers can enroll here. Currently enrolled providers can login to AHCCCS Online.

  • Q13: How should MCOs handle rejects at point of sale for pharmacies? Will there be exceptions for lifesaving prescriptions (such as inhalers) and hospital discharges?

    A13: AHCCCS members will not and should not be financially responsible for any out of pocket expenses for service or prescription that was made by a non AHCCCS registered provider. The financial responsibility will remain with the MCO.

  • 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 member’s primary or secondary insurance.