ORP claim denials for UnitedHealthcare Community Plan of Ohio

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

If you are billing services involving an ORP health care professional, you must include the National Provider Identifier (NPI) number on your claim. Claims submitted without an NPI number will be denied 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.