Behavioral Health Services
Basic Primary and Preventive Services
A basic package of primary and preventive behavioral services, such as screenings for depression, anxiety and substance abuse is available to every SoonerCare member without prior authorization for services delivered by a Patient-Centered Medical Homes, Indian/Tribal/Urban (I/T/U) Clinics, and Federally Qualified Health Centers. Other specialty providers, (i.e., public and private outpatient behavioral health agencies, and private independent licensed practitioners) must complete preadmission forms.
Education and Billing
- Behavioral Health Advisory Council (BHAC)
- Behavioral Health Delivery in School Settings
- Behavioral Health Telehealth Services (Updated July 18, 2018)
- Claims Tools
- CPT/Diagnosis Code Crosswalks
- SoonerCare-Approved Behavioral Health Screening Tools and Guidelines
- SoonerCare Billing and Procedure Manual
Fee Schedules/Getting Paid
- TFC Rates and Codes - 6/3/2020
- Rates and Codes for Outpatient Behavioral Health Agencies - Effective 9/9/2019
- Physician Fee Schedules
- Per Diem Fee Schedule
- Independent LBHP Rates and Codes - effective 1/1/2019
- Psychologist Rates and Codes - effective 1/1/2019
- Private LBHP Rates and Codes - 9/1/2015
- Private LBHP Rates and Codes - 7/1/2013
- Private LBHP Rates and Codes - 1/1/2013
- Psychologist Rates and Codes - 7/1/2013
- Psychologist Rates and Codes - 1/1/2013
Click here to access the web-based behavioral health provider directory.
Inpatient Hospital and Residential Services
Inpatient Hospital and Residential services for SoonerCare members under the age of 21 must be prior authorized before the service is provided. Telephonic initial and concurrent reviews to determine Medical Necessity Criteria (Manual) are required for the following services:
- 1-1 Staffing Per Diem Prior Authorization Request
- Adult Ages 18 to 64 Inpatient Medical Detox PA Request Form
- Adult Ages 18 to 64 Inpatient Psychiatric PA Request Form
- Behavioral Health Prior Authorization Correction Request
- BH Specialty Add-On Payment Examples
- BH Specialty Add-On Payment Prior Authorization Requests
- Child/Adolescent Under 18 Inpatient Admission PA Request Form
- Child/Adolescent Under 18 Inpatient Extension PA Request Form
- Conditions of Treatment Participation Inpatient Psych Programs for Children
- ECT Prior Authorizations
- Guidance for Using the Inpatient Behavioral Health and TFC Prior Authorization Templates
- Inpatient Discharge Notification Form
- Non-Verbal Per Diem Prior Authorization Request
- Psychiatric Residential Treatment Facility Attestation
- TFC-ITFC Notice of Admission PA Request
- TFC-ITFC Extension PA Request
Preadmission and Level of Care Services
Public and private outpatient behavioral health agencies, and private independent licensed practitioners must complete the Customer Data Core (CDC) Form and submit to the OHCA designated behavioral health utilization management and quality improvement organization. Currently this information must be submitted via the PI Client Information System. The information provided for pre-admission is brief and is primarily used to track the utilization of various services.
Preadmission services do not require clinical review and will be approved unless the member has exhausted the benefit or another provider has requested prior authorization for additional services.
Prior Authorization Requests
Prior authorization is required for members who require service intensity or duration beyond the pre-admission level.
- Client Assessment Record (CAR)
- Customer Data Core (CDC) PA Forms (ODMHSAS site)
- Electroconvulsive Therapy Guidelines
- Member ID Correction Form
- Prior Authorization Manual
- Prior Authorization Guidelines for Psychosocial Rehabilitation Services Beginning August 1, 2014
- Prior Authorization Procedure Code Groups
Prescription Medication Guidelines
Reports and Evaluations, Outcomes
- 2013 Oklahoma Systems of Care, Successful Outcomes
- 2012 ECHO Child Behavioral Health Survey
- 2010 Behavioral Health Quality Assessment and Performance Improvement (QAPI)
- 2010 ECHO Child Behavioral Health (Survey)
- 2009 ECHO Adult Behavioral Health (Survey)
- 2009 Mental Health State Report Card
- 2009 Monthly Behavioral Health Reports (OHCA)
- 2009 Review of SoonerCare Behavioral Health Services – (Mathematica)
These Web Alerts will send an email notification when there is a new posting for a proposed rule change. With each posting on this page, there is an opportunity to complete an electronic feedback form.
The OHCA seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed rule changes page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.
Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.
(800) 522-0114 and have your Provider ID number ready.
- Option 1 for Provider
- Option 6 for Prior Authorizations
- Option 2 for Behavioral Health
- (405) 248-9326