New ORP claim denials for UnitedHealthcare Community Plan of Ohio

Claims without an NPI number will be denied

Starting May 1, 2025, the state of Ohio requires that claims include a valid National Provider (NPI) number for the ordering, referring and prescribing (ORP) health care professional. UnitedHealthcare Community Plan of Ohio will deny claims that do not contain a valid NPI.

If you are an ORP health care professional, you must include a National Provider Identifier (NPI) number on your claim. Claims submitted without an NPI number will be returned with a Y42 denial and the following message(s):

• OH Ordering NPI Not Submitted on Claim (behavioral health)
• OH Ordering or Referring NPI Not Submitted on Claim

What to do if you receive a Y42 denial

If you receive a Y42 denial, please submit a corrected claim based on your UnitedHealthcare Provider Agreement timely filing deadline. If you do not submit a corrected claim on time, we will deny the claim for timely filing.

Resources

• Learn how to send a corrected claim
• Find additional information about which procedures require an NPI number for ORP health care professionals

Questions?

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