Medi-Cal ORP Enforcement Outreach and Engagement
Providers who order, refer, or prescribe (ORP) care for Medi-Cal members must be enrolled in Medi-Cal with their Type 1 National Provider Identifier (NPI). This is a federal requirement.
DHCS is starting a multi-year effort to make sure these providers are enrolled and correctly listed on claims with a valid Type 1 (individual) NPI. Doing this helps keep Medi-Cal accurate, protects members’ access to care, and meets federal rules.
The requirement applies across all three Medi-Cal billing systems:
- Pharmacy (Medi-Cal Rx)
- Medical (CA-MMIS)
- Behavioral health (Short-Doyle)
What Providers Need to Know
- Providers who order, refer, or prescribe must enroll in Medi-Cal using a Type 1 (individual) NPI.
- DHCS will publish a timeline showing the planned phases to enforce the requirement across billing systems.
- Claims may be denied if the ordering, referring, or prescribing provider isn’t enrolled.
- Enroll now to prevent interruptions in member care and avoid payment denials.
Resources
Medi‑Cal ORP Provider Enrollment Office Hours
To support health care organizations and providers seeking information about Medi‑Cal ORP provider enrollment, the DHCS Pharmacy Benefits Division, Provider Enrollment Division, and CA‑MMIS will host four 45‑minute Office Hour sessions between October 15–23, 2026.
These sessions give you a chance to:
- Ask questions about enrollment requirements
- Get support with the PAVE application process
- Share feedback related to federal compliance efforts
Office Hours supplement earlier Town Halls (July 30, September 24) and the August Forums on individual provider enrollment enforcement.
Office Hours Schedule
- Thursday, October 15, 2026 – 4:00–4:45 p.m.
- Tuesday, October 20, 2026 – 1:30–2:15 p.m.
- Thursday, October 22, 2026 – 11:00–11:45 a.m.
- Friday, October 23, 2026 – 12:30–1:15 p.m.
How to Join
All sessions use the same Microsoft Teams link. A separate invitation will not be sent.
Meeting ID: 239 199 416 046 481
Passcode: oE9kg6iV