Ordering, Prescribing, and Referring Providers

The law requires that services, supplies, and medications received by a Medicaid member be ordered or prescribed by a provider who is enrolled in Medicaid in order for Medicaid to pay.   This means if you go to a doctor who is not enrolled in Medicaid and that doctor:

  • writes you a prescription,
  • refers you for lab work,
  • gives you an order for medical supplies or equipment, or
  • refers you to another provider for services,

Medicaid cannot pay for that prescription, lab work, supply, or other service. Your pharmacy, lab, supplier, or other provider may not be willing to provide those services without payment from you first.

If your doctor is not enrolled, you can tell them Medicaid will not pay for the services they are requesting for you. Explain that Indiana Medicaid has made it simple for doctors who may see only a few Medicaid  patients to enroll. Suggest they go to the Ordering, Prescribing, and Referring Provider website or call 1-800-577-1278 for more information.