Global Messages

Provider Types: 03, 06

The Office of the State Coordinator for Health Information Exchange (HIE), along with the State Designated Entity, MyHealth Access Network, and partners at OFMQ invite you to an in-person HIE Connect Event for long-term care providers. The event will be held from 3-6 p.m., Tuesday, Dec. 3. It’s an opportunity for long-term care providers to discover how the HIE can streamline continuity of care, offer access to resident data, improve care coordination, and explore cost saving opportunities through OKSHINE programs.

View more details or register for the event.

PV Type: All

Provider Letter 2024-20 PA Criteria for MRI of the Lumbar Spine for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program is now available on the the provider letters page of the OHCA website. The letter informs providers that Oklahoma Complete Health and Children’s Specialty Program will implement changes related to PA criteria for MRI of the Lumbar Spine for dates of services on or after November 1, 2024.

SoonerCare Low-Dose CT Lung Cancer Screening Overview Webinar

Provider Types/Specialties: 01, 08, 09,10, 11, 16, 31, 52

The Oklahoma Health Care Authority, in partnership with the Oklahoma Hospital Association, will present a SoonerCare webinar at noon, Thursday, Nov. 7. Register here.

Providers will be introduced to components of SoonerCare’s low-dose CT lung cancer screening benefits. Topics to be explored include CMS updated guidelines, Oklahoma State of Lung Cancer Report, most updated eligibility criteria for Medicaid, shared decision-making visit requirements, the importance of continued tobacco cessation counseling and follow ups, and billing and coding information.

The webinar is available for all SoonerCare providers interested in ensuring that they are up to date with the most recent CMS guidelines for SoonerCare’s low-dose CT lung cancer screening benefits, as well as for providers who can perform and bill for the shared-decision making and CT screening.

Provider types:  24/240, 241

Register for a webinar at 10 a.m., Wednesday, Nov. 6, 2024, to learn about recent SoonerCare policy changes that allow vaccinations to be performed in the pharmacy by a pharmacist. This change is effective Nov. 1, 2024. Pharmacy groups, pharmacists and staff will learn about contracting requirements, coverage and services, billing requirements, and utilizing the secure provider portal.

Provider Type: 31/All Specialties

OHCA has extended the expiration date of physician contracts from Oct. 31, 2024 to Nov. 30, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members.

We currently have over 14,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit renewals as soon as possible.

You can log into the provider portal to complete your renewal. If you need assistance logging in, please contact the helpdesk at 800-522-0114, option 2, option 1. Or you can email SoonerCareInternetHelpdesk@gainwelltechnologies.com.

Provider types: 01, 08, 09, 10, 28, 31, and 52

Effective Nov. 1, 2024, OHCA will require a prior authorization for CPT 81595 – cardiology heart transplant MRNA (AlloMap). Prior authorization guidelines for this molecular pathology testing can be found on the OHCA website.

Type: ALL

OHCA and Gainwell will be implementing security updates to strengthen the overall data protection of our provider portal on Nov. 7, 2024. Most users will not be affected by these changes, but billing agencies, software companies and other trading partners should be aware that we are upgrading the hashing algorithm to a more current and secure version. If you have issues logging in on Thursday, Nov. 7, please contact your vendor or our EDI Helpdesk at 800-522-0114 option 2, 2.

Provider types: 08, 09, 10, 13, 17, 31, and 52

Effective Nov. 15, 2024, OHCA will require a prior authorization for developmental testing codes 96112/96113 and neurobehavioral status exam codes 96116/96121 when performed by a medical provider.  Prior authorization for this testing is already required for behavioral health providers and there are no changes to that process. This change is being made in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) which ensures parity between behavioral health services and medical services. Prior authorization guidelines for medical providers can be found on the OHCA website.

Provider Types: 08, 09, 10, 11, 14, 31, 53, and 60

Thank you for your patience as we set up this new incentive payment program. Last week, eligible providers began receiving supplemental payments for services rendered to SoonerSelect health and SoonerSelect Children’s Specialty Plan members. These supplemental payments will be lump-sum enhancements to base fees paid by the SoonerSelect contracted entities. 

As a reminder, providers must meet the following criteria to be eligible for payment under this arrangement:

• In-network with a contracted entity. Only in-network paid claims will be evaluated for enhancement. If you are not yet in-network but execute a contract in the contract year (prior to June 30, 2025), you will become eligible for future incentive payments.
• The rendering provider must be an advanced practice nurse, mid-level practitioner, mental health provider or licensed behavioral health practitioner, podiatrist, physician, or anesthesiologist assistant.
• The billing provider cannot be:
  • Eligible for a separate State-Directed Payment program, including academic medical center-affiliated physicians and Community Mental Health Centers (CMHCs).
  • Clinics, including but not limited to public health clinics, FQHCs, RHCs, ITU clinics, and dental clinics.
  • A therapy (OT/PT/ST/RT) group.

The initial supplemental payment will be for SoonerSelect paid claims with dates of services between April and June 2024. You will only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced in this and future payments. Subsequent supplemental payments will be made after the end of each quarter.

• The contracted entities, as directed by OHCA, will distribute these payments. 
• Unless organizations have multiple TINs, they will receive one payment. The payment schedule on the website will list payments by billing provider.
• Contracted entities may reach out to you to set up payment. Please respond, or payment will be delayed.
• Payments may be an electronic funds transfer (ETF), but most payments will be paper checks delivered via mail, which will take 7-10 days. Please reach out to the contracted entities if interested in receiving payment via EFT in future payments.

The SoonerSelect provider incentive program originates from 2022 OK SB1396 and requires approval from the Centers for Medicare & Medicaid Services (CMS). OHCA will evaluate the program design, including eligible providers and payment allocation annually, to ensure the program aligns with the goals of the SoonerSelect Quality Strategy. CMS approval is an annual process, and the program is subject to disapproval or change in future years. For a payment schedule, please view at SHOPP Forms and Reports (oklahoma.gov). For additional information, please view the Provider Incentive Directed Payment Program guide.

Run Date: 09/30/2024 – 10/31/2024

PV Type:  03/30, 31, 34, 35

Long-term care provider cost reports for SFY 24 are due by Oct. 31, 2024.

Facilities may be subject to a rate reduction, equal to the amount of the direct care portion of the daily rate, ranging from $36.10 to $73.38 per patient day, if cost reports are not received in a timely manner. 

Thank you for your attention to this matter.

Providers: 01, 08, 09, 10, 28, 31, 52

Effective Oct. 1, 2024, OHCA is expanding coverage for 87631 (RESP 3-5 TARGETS). This code was previously only covered in the outpatient hospital setting, but OHCA will now reimburse for this testing when performed by a hospital laboratory, physician/clinic lab, or independent lab for medically necessary covered indications. OHCA has updated the Molecular Diagnostic Testing for Infectious Diseases coverage guideline with the information below. This coverage guideline can be found on the Medical Authorization Unit web page

87631 – Respiratory virus (e.g., adenovirus, influenza, coronavirus, metapneumovirus, parainfluenza virus, RSV, rhinovirus) includes multiplex reverse transcription when performed, and multiplex amplified probe technique, multiple types, or subtypes, 3-5 targets.

• Testing covered when performed by a hospital lab, independent lab or clinic lab for the following indications:

• At this time, the evidence supporting testing in the outpatient setting is limited to individuals who are at high risk for complications of respiratory viral infection —including immunocompromised individuals, those with chronic respiratory illness, influenza complicated by pneumonia, or pregnant — when the result of testing is used to guide or alter management. 
• Evidence does not demonstrate clinical utility in average risk individuals in the outpatient setting; use of these tests has not been shown to change treatment decisions and improve subsequent clinical outcomes.

Provider Type: 31/All Specialties

OHCA has extended the expiration date of physicians from Sept. 30, 2024, to Oct. 31, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members.

There are currently more than 14,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit renewals as soon as possible. You can log into the provider portal to complete your renewal.

If you need assistance logging into the provider portal, please contact our helpdesk at 800-522-0114, option 2, option 1, or via email at SoonerCareInternetHelpdesk@gainwelltechnologies.com.

Provider Types/Specialties: All

The continuity of care provision extension for provider contracting with our partners Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health to be in-network and reimbursed at 100% of the SoonerCare fee schedule is ending Oct. 1. Therefore, if you are not fully contracted with the plans by Oct. 1, you will be considered out-of-network, and the reimbursement rate will be at 90% of the SoonerCare fee schedule.

Provider Types/Specialties: All

Provider Letter 2024-19 SoonerSelect Cumulative Refill Too Soon Threshold for Aetna Better Health of Oklahoma is now available on the provider letters page of the OHCA website. The letter informs providers that Aetna Better Health of Oklahoma will implement changes related to pharmacy refill thresholds for dates of service on or after Oct. 1, 2024.

PROVIDER TYPES: 01, 02, 03, 05, 06, 08, 24, 25, 26, 28, 29, 30, 63

The Oklahoma Health Care Authority and the Office of the State Coordinator for Health Information Exchange are hosting a webinar to discuss the integration of Electronic Heath Records (EHRs) with the Health Information Exchange (HIE). It will take place from 11 a.m.-12:30 p.m.,  Thursday, Oct. 10.

The session will explore the collaborative efforts required between health care providers and their EHR vendors to effectively connect to the HIE and facilitate seamless data sharing across systems. It will also highlight available State of Oklahoma funding options for EHR systems and health care providers to support this integration.

Key takeaways for attendees will include:

• The role of HIE connectivity in fostering effective patient care and data exchange.
• How to access and utilize funding programs to support integration efforts.
• Practical guidance on aligning EHR systems with regulatory requirements and improving overall interoperability.
• A deeper understanding of data blocking rules and their impact on EMR vendors and health care providers.

Forward this message to your EHR vendor representative(s) to ensure they have an opportunity to attend. Vendors are encouraged to register today to ensure their customers are well-prepared for successful HIE integration and compliant with data blocking regulations.

Provider types:  All

Message:  Do you have taxonomy issues, questions, or problems? Great news! OHCA, in conjunction with our partners, is hosting Q&A sessions for providers to ask the experts. The sessions will occur every other Tuesday at 10 a.m. from Sept. 24-Dec. 31, 2024. When you register, you will be automatically signed up for every session. Attend as many sessions as you would like.

Provider Types: 02, 08, 31, and 52

Effective Sept. 1, 2024, OHCA has extended coverage for hernia repair codes 49591, 49592, 49593, 49594, 49595, 49613, 49614 and 49615 to allow reimbursement when provided in an ambulatory surgery center.

Provider Types: 01, 08, 09, 10, 28, 31 and 52

Effective Sept. 1, 2024, OHCA has opened coverage for CPT 81517, a serum based enhanced liver fibrosis (ELF) test. It will be allowed up to two times per year for members with chronic liver disease for whom liver fibrosis determination is necessary.

Provider Types: 08, 09, 10, 25, 31, and 52

Effective Oct. 15, 2024, OHCA will require a prior authorization (PA) for ultrasonic bone growth stimulators billed with HCPCS code E0760 (osteogenesis stimulator, low-intensity ultrasound). For SoonerCare members not enrolled in a SoonerSelect plan, authorization will be completed through the provider portal where InterQual criteria will be utilized. For members enrolled in a SoonerSelect plan, providers will need to contact the plan for specific coverage and PA guidelines. As a note, prior authorization is already required for electrical bone growth stimulators and there will be no change to that process. 

Provider Type/Specialty: 27/270-279, 08/081 & 086

Effective Aug. 15, 2024, OHCA has opened coverage for D2929 (PREFABRICATED PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH). D2929 is covered for TXIX, HAP and CUST members ages 0-20 with no prior authorization required. Pricing is set at $121.95. Coverage and pricing changes will be added to the online dental fee schedule with the next scheduled quarterly update.

Provider types: All

Message: OHCA is hosting a webinar featuring each partner and their subject matter experts. Please join one or more sessions to ask questions, provide feedback and report issues.

• Humana Healthy Horizons in Oklahoma
Tuesday, Sept. 17 at 10 a.m.
Register

• Oklahoma Complete Health
Wednesday, Sept. 18 at 10 a.m.
Register

• Aetna Better Health of Oklahoma
Wednesday, Sept. 18 at 2 p.m.
Register

Provider Types: 31 - Physicians

We currently have over 18,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit your renewals as soon as possible. You can log into the provider portal to complete your renewal.

Please note that Provider Enrollment does not have access to assist with provider portal issues. If you need assistance, contact our internet helpdesk at 800-522-0114, option 2, then option 1. Or email soonercareinternethelpdesk@gainwelltechnologies.com.

This contract is set to expire on Sept. 30, 2024. If you have contract questions, please contact Provider Enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org.

Provider types: 08, 09, 10, 13, 31, and 52

Effective Oct. 1, 2024, OHCA will require a prior authorization for psychological/neuropsychological testing codes 96130-96146, when performed by a medical provider. Prior authorization for this testing is already required for behavioral health providers, and there are no changes to that process. This change is being made in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) which ensures parity between behavioral health services and medical services. Prior authorization guidelines for medical providers can be found on the OHCA website.

Provider Type: 08, 09, 10, 11, 14, 31, 53, and 60

Beginning in September, eligible providers will begin receiving supplemental payments for services rendered to SoonerSelect health and SoonerSelect Children’s Specialty Plan members. These supplemental payments will be lump-sum enhancements to base fees paid by the SoonerSelect contracted entities.

Providers must meet the following criteria to be eligible for payment under this arrangement:

• In network with a contracted entity. Only in-network paid claims will be evaluated for enhancement. If you are not yet in-network but execute a contract in the contract year (prior to June 30, 2025), you will become eligible for the incentive program.
• The rendering provider must be an advanced practice nurse, mid-level practitioner, mental health provider or licensed behavioral health practitioner, podiatrist, physician, or anesthesiologist assistant.
• The billing provider cannot be:
  • Eligible for a separate State Directed Payment program, including academic medical center-affiliated physicians and Community Mental Health Centers (CMHCs).
  • Clinics, including but not limited to public health clinics, FQHCs, RHCs, ITU clinics, and dental clinics.
  • A therapy (OT/PT/ST/RT) group.

The initial supplemental payment will be for SoonerSelect paid claims with dates of services between April and June 2024. You may only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced. Subsequent supplemental payments will be made after the end of each quarter. The contracted entities, as directed by OHCA, will distribute these payments.

For additional information, please view the Provider Incentive Directed Payment Program guide.

Provider types: 08, 09, 10,13, 16, 31, 52

The Focus Forward Oklahoma Program is working to address issues related to access and utilization of long-acting reversible contraceptives (LARC). There are currently four trainings scheduled: Nov. 9, 2024; Dec. 14, 2024; April 5, 2025; and May 17, 2025.

Focus Forward Oklahoma offers no-cost LARC training to Oklahoma providers, clinical support staff and administrative staff. For more information about Focus Forward and available training, visit our Provider Training webpage.  

Long-Term Care Enhanced Payment Update

ICF/IID Vocational & Day Services Enhanced Payment - Update

Run Date: 08/27/2024 – 09/06/2024

PV Type: 03/31,34

The SFY 2025 1st Quarter enhanced payment for vocational and day services will be made on Aug. 28, 2024.

We thank you for your continued service to SoonerCare members.

Run Date: 8/27/2024 – 9/6/2024

PV Type:  03/30, 35

The SFY 2025 1st Quarter PFP payment will be made on Aug. 28, 2024.

We thank you for your continued service to SoonerCare members.

Run Date: 8/21/2024 – 9/13/2024

PV Type:  03/30, 35

The OHCA Board approved SFY 2025 per diem rates for regular nursing facilities on Aug. 12, 2024. The new rates will be retroactive to July 1, 2024. To ensure all services provided in SFY 2025 are paid at the new rates, a payment reconciliation will be completed to account for any underpayments for services provided between July 1-Aug. 13, 2024.

The adjustments will be made on Aug. 28, 2024, remittance.

Thank you for the services you provide to our long-term care members.

If you have any questions, don't hesitate to contact Fred.Mensah@okhca.org.

Provider Type/Specialty: 27/270-279, 08/081 & 086

Dental providers must comply with the American Dental Association’s (ADA) Current Dental Terminology (CDT) when billing for surgical extractions, D7210. Providers must clearly document the medical necessity for the surgical extraction, supported by radiographic images and clinical narrative(s) in the patient’s medical record.

After review of historical billing practices for D7210 in the SoonerCare program, OHCA observed a history of misapplication and/or erroneous coding practices for this code.

Effective June 1, 2024, OHCA approved modified guidelines and changes for both SoonerSelect dental plans, DentaQuest and LIBERTY Dental, as it pertains to D7140 and D7210. Please refer to Provider Letter 2024-11 which outlines the approved modified guidelines in detail.

Effective June 1, 2024, the SoonerSelect dental plans began implementing modified prepayment reviews for D7210. If modified prepayment review of D7210 finds insufficient clinical documentation and/or evidence of the need for surgical extraction, the dental plans have OHCA approval to down-code the service to a D7140.

OHCA and the SoonerSelect dental plans will continue to monitor billing practices for D7140 and D7210 in both the SoonerSelect dental and the SoonerCare fee-for-service programs. Providers who consistently demonstrate a pattern of misapplication of these CDT codes may be subject to recoupments and/or referral(s) for investigation into fraud, waste and abuse. 

Provider Types:  27/270-279, 08/081 & 086

Concerning dentures, adjustments, tissue conditioners and relines, OHCA protocol states a provider is responsible for denture maintenance and feasibility for 24 months (2 years) from delivery. The provider must deliver a prosthesis that is reasonably functional and esthetically presentable. Any adjustments or additions (e.g., tissue conditioners) associated with the initial delivery and within 24 hours of delivery are included in the initial reimbursement and are not separately billable.

All adjustments and/or tissue conditioners done on same date of delivery cannot be charged separately and are all included in the denture fee. Separate billing is allowed for adjustments (using appropriate CDT codes D5410, D5411, D5421 or D5422) performed after the delivery of the prosthetic up to 3 times per arch per 12 months. Additionally, separate billing is allowed for tissue conditioner (using appropriate CDT codes D5850 or D5851) if documentation supports the service is medically necessary for healing, tissue changes or to facilitate proper fit and function. Adjustments associated with tissue conditioners and/or hard relines on the date of service are included in the fee for the tissue conditioner or reline and are not reimbursable. Six months following the initial delivery of the prothesis, the member may be eligible for a hard reline if supported by documentation and medically (clinically) necessary. 

PV Type:  03/30, 35

The Oklahoma Health Care Authority Board approved SFY 2025 per diem rates for regular nursing facilities on Aug. 12, 2024. The new rates will be retroactive to July 1, 2024. To ensure all services provided in SFY 2025 are paid at the new rates, a payment reconciliation will be completed to account for any underpayments for services provided between July 1-Aug. 13, 2024.

Reconciliation payments will be made to providers as soon as possible. The payment date will be communicated to providers by the end of August 2024.

Thank you for the services you provide to our long-term care members.

If you have any questions, don't hesitate to contact Fred.Mensah@okhca.org.

Provider Types:  27/270-279, 08/081 & 086

This guidance pertains to coverage of caries risk assessment (CRAs) codes D0601, D0602 and D0603. The dental provider’s evaluation of each individual member’s caries risk will determine the correct D code to submit for reimbursement, depending upon whether the member is found to be low, moderate or high risk. A completed CRA may be reimbursed once per member per year.

Per OHCA policy, a member must be caries-free for the previous 12 months before they can be referred to an orthodontist for an orthodontic evaluation. OHCA strongly recommends CRAs be completed regularly by the member’s primary care dentist (PCD) and maintained within the member’s chart. A completed CRA should be included in referral paperwork for orthodontic evaluations.

If you are a SoonerSelect participating provider, the proper application and billing of CRA codes can help maximize access to value-added benefits available exclusively through the contracted SoonerSelect Dental plans. For questions about the SoonerSelect dental program, please refer to the member’s dental plan, DentaQuest and/or LIBERTY Dental, using the contact information available online at SoonerSelect Provider Resources. 

Provider types/specialties: All

ATTENTION EDI SUBMITTERS, TRADING PARTNERS, SOFTWARE VENDORS AND PROVIDERS:

OHCA moved to a new translator on July 15, 2024. Some of the changes you will notice are outlined below; please make any corresponding updates to your system as needed. If you have any questions, contact the EDI helpdesk at 800-522-0114, option 2, 2.

1. ISA08 and GS03 MUST be 731476619. If this ID is not used, the file will error, and nothing will be returned.
2. Values in ISA06 and GS02 must match the trading partner ID of the trading partner that uploaded the file. Example: If you are logged in under the 'A' location, you can only submit files for the 'A' location. If the correct ID is not used, the file will error, and nothing will be returned.
3. Leading zero(s) are not allowed in GS06.
4. 820 RMR01 will change from 11 to AZ.
5. 837 files will now send back 277CA files as needed.
6. TA1 files will now be sent back as needed.
7. A readable HTML report of any compliance errors will be sent as needed.
8. A 276 transaction set that uses the 2000E dependent loop will fail compliance.

Provider Type: 31

To ease the renewal experience for physicians, OHCA has unlocked Provider Portal accounts for those providers who will expire on Sept. 30, 2024, or were locked out of their individual portals due to inactivity. If you do not remember your login information, reach out to our helpdesk at 800-522-0114, option 2, then option 1. Or email SoonerCareInternetHelpdesk@gainwelltechnologies.com. Please be sure to log into your portal and start the renewal process prior to Sept. 30, 2024 to prevent coverage gaps.

Provider Types: 01, 08, 09, 10, 31, and 52

Effective Aug. 1, 2024, OHCA will cover CPT 58674 - DESTRUCTION OF GROWTH OF UTERUS USING AN ENDOSCOPE WITH ULTRASOUND GUIDANCE AND MONITORING (Acessa procedure) for treatment of uterine fibroids. Coverage will be for ages 10-60 and no prior authorization will be required.  

Provider Types:  07, 08, 09, 10, 11, 12, 13, 16, 17, 18, 19, 20, 21, 23, 31, 36, 52, 53

Please complete the school-based services needs assessment survey by July 30, 2024.

This survey is from the Oklahoma State Department of Education and the Oklahoma Health Care Authority for school-based Medicaid services. School-based Medicaid services are currently pursuant to an Individual Education Plan (IEP) in the state of Oklahoma. School-based Medicaid services do not limit access to health services in the community; instead, they complement community health resources by providing additional care and support to eligible students directly within the school environment.

School-based Medicaid Survey

Email Kellie Carter, program manager for school health at the Oklahoma State Department of Education, for questions, comments or concerns at kellie.carter@sde.ok.gov, or Lana Brown, school-based services manager at the Oklahoma Health Care Authority at lana.brown@okcha.org.

This survey is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2.5 million with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of nor an endorsement by CMS/HHS or the U.S. government.

Provider Types:  All

Join us for an overview of OHCA’s taxonomy assignment process with our SoonerSelect health plan partners Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health.

Register for the morning session at 10 a.m. on Wednesday, July 17, 2024.

Register for the afternoon session at 2 p.m. on Wednesday, July 17, 2024.

SFY 2024 Cost Report

Run Date: 07/01/2024 – 10/31/2024

PV Type:  03/30, 31, 34, 35

This is a reminder to long-term care providers that all cost reports for the State Fiscal Year ending June 30, 2024, will be due on or before Oct. 31, 2024.

You must report costs electronically via the OHCA provider portal, unless you are submitting a partial year cost report. All partial year cost reports must be submitted using the Data Entry File for Partial Year Reporting form.

If a change of ownership has occurred and you have an entire year of data available, then the two partial reports must be combined and entered in the provider portal.

New Update for ICF/IID Facilities Participating in the Enhanced Payment for Vocational and Day Services Program: The expenses for vocational and/or day services previously reported on the “office expense” schedule will now be reported in “general expenses.” Please make sure you report all costs for activities or items directly traceable to vocational and/or day services (excluding staffing and overhead) on the general expenses schedule. You will enter the total amount of these expenses in the fields titled: Vocational Services Cost (ICF ONLY), and/or Day Services Cost (ICF ONLY).

In addition, we are entering our second year of the Enhanced Payment for Vocational and Day Services Program. This means, starting in SFY 26, the calculations pertaining to the Direct Cost Component of the rate, will be calculated using relative direct day services cost and relative direct vocational services costs reported by each facility, on the most recent annual cost report.  ICF/IID providers participating in the Enhanced Payment for Vocational and Day Services Program will be required to report all program expenses on the current year’s cost report. Failure to report vocational and/or day services costs could adversely impact payment under the Enhanced Payment for Vocational and Day Services Program.

Thank you for the services you provide to SoonerCare members.

Provider types/specialties: 08/087, 182, & 17/145, 170-175, 179

To help you prepare for the Centers for Medicare and Medicaid Services’ annual rate adjustment period, OHCA released an advanced notice of rate changes for billing codes. The updated rates for CPT codes, which are used by multiple provider types, will be effective July 1, 2024. 

The majority of OHCA's fee schedule is based on CMS's fee schedule, and CMS adjusts its rate every year. This adjustment happens outside of any program changes Oklahoma has completed during the current year or any future year. 

CMS rates are connected to a conversion factor, which is adjusted annually. However, CMS uses other variables to calculate the rate for each code. These include things such as work time, malpractice and practice expense. They are all multiplied by the conversion factor to calculate the rate for each code. These additional factors mean that the amount individual codes change varies from one code to the next.

We provide advance notice to ensure you have adequate time to update your billing systems and integrated software in preparation for the updated rates.

SoonerSelect contracted entities are required to reimburse in-network providers no less than 100% of the OHCA fee schedule through July 1, 2026. These fee schedule changes, though not initiated by the contracted entities, will be used by the contracted entities beginning July 1, 2024, to align with OHCA’s fee schedule.

You can learn more about the federal rate-setting process on the CMS website.

Providers: All

Effective July 1, 2024, OHCA will add modifier 95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications systems) as an allowed modifier to report services delivered via telehealth. More information about telehealth and services allowed to be delivered via telehealth can be found on the provider telehealth page.

PV Types:    01, 08, 31, 52

C-section rate letters for the first six months (July–December) of state fiscal year 2024 are available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.

If you need help retrieving your letters, please call 800-522-0114.

You may also view the SoonerCare C-section rates and reports available at OHCA’s Cesarean Reports page.

Thank you.

Provider type/Specialties:  53/536

OHCA is aware of an issue that is preventing certain behavioral health agency types from being reflected in the system as an eligible option for provider types currently renewing or submitting new applications. To preserve the ability to renew for currently enrolled providers, we need to identify specific providers currently affected by this issue. 

If you are a currently an under-supervision candidate attempting to renew, and have not been able to complete the renewal because one or more agencies of employment are not available as eligible service locations, please email ProviderEnrollment@okhca.org as soon as possible. Include your Provider ID number and current application tracking number (ATN) if available.

Nursing Facility Pay for Performance (PFP) Payment Update

Run Date: 5/27/2024 – 6/7/2024

PV Type:  03/30, 35

SFY 2024 4th Quarter PFP payment will be made on May 29, 2024.

We thank you for your continued service to SoonerCare members.

Long-Term Care Enhanced Payment Update

ICF/IID Vocational & Day Services Enhanced Payment - Update

Run Date: 05/27/2024 – 06/07/2024

PV Type: 03/ 31,34

SFY 2024 4th Quarter enhanced payment for vocational and day services will be made on May 29, 2024.

We thank you for your continued service to SoonerCare members.

Provider types/ specialties: All

OHCA has identified that our system is not backdating the effective dates of health and dental plans to the dates of birth of deemed newborns. A newborn is considered deemed only when the mother was on SoonerCare at the time of the baby’s birth. 

The system work to correct this is anticipated to take up to 10 months or more. In the meantime, our eligibility team will be manually backdating the plan effective dates to the date of birth of the deemed newborn when possible. 

We are currently working through a list of newborns born between April 1-May 17, 2024, and anticipate completion of this list by June 20, 2024. Starting May 27, we will be working through a weekly list of newborns who have dates of births from the week prior.  Please allow at least two weeks for the necessary updates to be made to the newborns’ plans.

You may still add newborns via the eNB1 process as those babies will show on our report to correct their plan effective date. You may also add newborns via the NB-1 process by using the NB-1 form and emailing it to NODOS-NB1@okhca.org.

Please use the provider portal to check the status of a newborn’s plan enrollment. If you have questions regarding a newborn’s plan effective date, please email NODOS-NB1@okhca.org.

Provider types/ specialties: 01, 08, 09, 10, 25, 31, and 52

Effective June 1, 2024, OHCA will require prior authorization for bathroom equipment codes E0244 (raised toilet seat), E0245 (tub stool or bench), E0247 (transfer bench) and E0248 (transfer bench, heavy duty). These items are manually priced and per OHCA policy 311: 30-5-211.3, all manually priced DME items require a prior authorization. Guidelines for these items can be found on the Durable Medical Equipment page.

Provider types/specialties: All

Representatives from the SoonerSelect health plans and the Children's Specialty Program will be at the Owasso Conference Center from noon-4 p.m., Thursday, May 30.

This is a chance to have your SoonerSelect questions answered in person, so make plans to stop by and talk directly with a plan representative from Aetna Better Health, Humana Healthy Horizons or Oklahoma Complete Health.

Each of the plans continues to hold virtual office hours as well. Visit the provider resources page for a listing of hours and links.

Provider types/specialties: All

The General Agreement between a provider and the Oklahoma Health Care Authority, Article IV, Scope of Work states: “Unless otherwise specified in the Special Provisions for provider’s type, Provider agrees to the following: (f) To comply with all applicable statutes, regulations, policies, and properly promulgated rules of OHCA.”

All policies and rules can be found on OHCA’s public website at the following link: Policy and Rules (oklahoma.gov).

Claims not compliant with OHCA policy are identified as payment errors and subject to recoupment during an audit. The OHCA would like to highlight three recurrent issues being identified and the applicable policy.

1. All providers rendering services to SoonerCare members must be contracted with OHCA.
2. All claims must accurately reflect the actual provider who rendered the billed service.
3. All documentation must be properly authenticated before the claim is submitted to OHCA for payment.

Contracted Provider:

O.A.C. 317:30-3-2 states: “In order to be eligible for payment, providers must have on file with OHCA, an approved Provider Agreement.”

Rendering Provider on Claim:

O.A.C. 317:30-3-1(b) states: “Payment to practitioners under Medicaid is made for services clearly identifiable as personally rendered services performed on behalf of a specific member. There are no exceptions to personally rendered services unless specifically set out in coverage guidelines.”

O.A.C. 317:30-5-1(1) states: “Payment to physicians under SoonerCare is made for services clearly identifiable as personally rendered services performed on behalf of a specific patient. There are no exceptions to personally rendered services unless specifically set out in coverage guidelines.”

Record Authentication:

O.A.C. 317:30-3-4.1(1)(E) states: “The authentication of an electronic medical record (signature and date entry) is expected on the day the record is completed. If the electronic medical record is transcribed by someone other than the provider, the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed. Before any claim is submitted to OHCA for payment of a provided service, the provider must authenticate the electronic medical records relating to that service.”

O.A.C. 317:30-3-30(b) states: “A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance, or obligation. The authentication of a medical record (signature and date entry) is expected on the day the record is completed. If the medical record is transcribed by someone other than the provider, the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed. Before any claim is submitted to OHCA for payment of a provided service, the provider must authenticate the medical records relating to that service.”

Provider Types/Specialties: 01/08/09/10/28/31/52

Effective May 1, 2024, OHCA is adding coverage for human platelet antigen genotyping codes 81105-81112. These services will be covered for ages 0-999 and will require a prior authorization (PA). The Genetic Molecular Pathology guidelines have been updated to include the criteria for this new coverage. 

Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

Dear SoonerSelect Provider,

During the SoonerSelect transition on April 1, 2024, members were assigned a primary care provider by their assigned/chosen health plan. Several factors were considered during this assignment process including historical PCP assignment information provided by OHCA, distance to provider from the member’s address and provider network status with the contracted entity. We understand that this may have caused disruption to your PCP panel assignments that you were accustomed to under SoonerCare Choice. In order to reduce disruption in care for SoonerSelect members, each of the contracted entities will be reassigning members, to the extent possible, back to their pre-implementation PCP unless a member has actively chosen a new PCP. Information regarding specific assignment information will be forthcoming from each of the SoonerSelect contracted entities. Reassignments are expected to take place over the next 7-10 days.

Provider types: 01, 08, 09, 10, 14, 28, 31, 52

Effective April 24, 2024, OHCA has updated coverage guidelines for Molecular Diagnostic Testing for Infectious Diseases. The latest guideline includes grammar and proofreading changes; there were no changes in coverage criteria.

Provider Types:  18 Optometrist/180 Optometrist, 19 Optician/190 Optician, 207 ITU Optician, 31 Physician/330 Ophthalmologist, 543 Pediatric Ophthalmology, 52 State Employed Physicians/330 Ophthalmologist, 543 Pediatric Ophthalmology

Description:  Join us for an overview of vision benefits and vision services provided by our SoonerSelect partners.

Register for the session with Aetna Better Health of Oklahoma at noon, Tuesday, May 7, 2024.

Register for the session with Humana Healthy Horizons in Oklahoma at noon, Wednesday, May 8, 2024.

Register for the session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at noon, Thursday, May 9, 2024.

Provider types/specialties:

081, 084, 088, 185, 199, 090, 092, 093, 100, 130, 316, 318, 320, 322, 328, 344, 345, 349, 359, 316, 318, 320, 328, 344, 345, 349, 359

Oklahoma is one of seven states identified in the 2019 End HIV Initiative that has a statistically disproportionate occurrence of HIV in rural areas. To increase awareness and incentivize providers to have crucial conversations with members surrounding HIV awareness and prevention, the Oklahoma Health Care Authority has approved the use of CPT code 99401 for HIV counseling.

CPT code 99401 is available for use:

• Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 15 minutes one time per year.
• 99401 is used for the purpose of promoting health and preventing illness or injury related to HIV counseling. This will increase awareness and prevention of the HIV disease process which can lead to a decrease in infection through proactive education.
• This code would not be for individuals who are already diagnosed with HIV or receive a positive HIV test result during the encounter. Rather, the intent is for preventive counseling conversations regarding risk for HIV infection. (Z71.7 Human immunodeficiency virus HIV counseling.)
• The use of this code must address HIV education, advisement of common risk factors and modes of transmission, identifying member’s specific risk factors, and collaboration with the member on a risk reduction plan.

Provider Types: All

Please update your OHCA provider files to ensure all details, including new or missing locations and group member assignments, are accurate. If your update impacts services under SoonerSelect partners, please email your Application Tracking Number (ATN), received upon submitting your update on the OHCA provider portal, to providerenrollment@okhca.org with "SoonerSelect update" and your Application Tracking Number in the subject line.

Provider types: 08, 09, 10,13, 16, 31, 52

The Focus Forward Oklahoma program works to address issues related to access and utilization of long-acting reversible contraceptives (LARC). No-cost LARC training is available to Oklahoma providers, clinical support staff and administrative staff. There are currently two trainings available on June 22, 2024 and June 29, 2024.

For more information about Focus Forward and available training, visit our provider training web page or view the flyer with additional details and registration code. 

Provider types: 08, 09, 10,13, 16, 31, 52

The Focus Forward Oklahoma program works to address issues related to access and utilization of long-acting reversible contraceptives (LARC). No-cost LARC training is available to Oklahoma providers, clinical support staff and administrative staff. There is currently one training scheduled in April 2024.

For more information about Focus Forward and available training, visit our Provider Training web page.

Provider Types:  All

Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim.

Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types.

Behavioral Health Providers

Click here to register for the Behavioral Health session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 9 a.m. on Thursday, April 11, 2024.

Click here to register for the Behavioral Health session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 2:30 p.m. on Tuesday, April 16, 2024.

PT/OT/ST

Click here to register for the PT/OT/ST webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 11:30 a.m. on Thursday, April 11, 2024.

Click here to register for the PT/OT/ST webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 9 a.m. on Tuesday, April 16, 2024.

All other providers

Click here to register for all other providers' webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 2:30 p.m. on Thursday, April 11, 2024.

Click here to register for all other providers' webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 11:30 a.m. on Tuesday, April 16, 2024.

Provider Types:  All

Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim.

Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types.

Behavioral Health Providers

Click here to register for the Behavioral Health session with Humana Healthy Horizons in Oklahoma at 9 a.m. on Wednesday, April 10, 2024.

Click here to register for the Behavioral Health session with Humana Healthy Horizons in Oklahoma at 2:30 p.m. on Thursday, April 18, 2024.

PT/OT/ST

Click here to register for the PT/OT/ST webinar session with Humana Healthy Horizons in Oklahoma at 11:30 a.m. on Wednesday, April 10, 2024.

Click here to register for the PT/OT/ST webinar session with Humana Healthy Horizons in Oklahoma at 9 a.m. on Thursday, April 18, 2024.

All other providers

Click here to register for all other providers' webinar session with Humana Healthy Horizons in Oklahoma at 2:30 p.m. on Wednesday, April 10, 2024.

Click here to register for all other providers' webinar session with Humana Healthy Horizons in Oklahoma at 11:30 a.m. on Thursday, April 18, 2024.

Provider Types:  All

Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim.

Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types.

Behavioral Health Providers

Click here to register for the Behavioral Health session with Aetna Better Health of Oklahoma at 9 a.m. on Tuesday, April 9, 2024.

Click here to register for the Behavioral Health session with Aetna Better Health of Oklahoma at 2:30 p.m. on Wednesday, April 17, 2024.

PT/OT/ST

Click here to register for the PT/OT/ST webinar session with Aetna Better Health of Oklahoma at 11:30 a.m. on Tuesday, April 9, 2024.

Click here to register for the PT/OT/ST webinar session with Aetna Better Health of Oklahoma at 9 a.m. on Wednesday, April 17, 2024.

All other providers

Click here to register for all other providers' webinar session with Aetna Better Health of Oklahoma at 2:30 p.m. on Tuesday, April 9, 2024.

Click here to register for all other providers' webinar session with Aetna Better Health of Oklahoma at 11:30 a.m. on Wednesday, April 17, 2024.

Provider Types:  All

Exciting news! If a member is enrolled in the SoonerSelect dental program (SoonerDental), you are now able to verify in which plan the member is enrolled. Click on the + (plus) sign in the Managed Care section of the eligibility screen and it will expand to show you the member’s plan name.

Example Image #1

Example Image #2

Please note:
If a member is in the SoonerSelect health program, this option will be available beginning April 1, 2024.

Provider Types:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

OHCA made the last PCMH care coordination payment for members transitioning to SoonerSelect on Feb. 28, 2024. The February 2024 payment is a prospective payment for March 2024.

Beginning April 2024, the contracted entities (CE) will make the PCMH care coordination payments for SoonerSelect members. Each CE will have a PCMH payment calendar; please see below for additional information regarding PCMH payments per plan. 

• Humana will make the April PCMH payment by April 17. Going forward, Humana PCMH payments will be paid monthly, no later than the 15th of the month.
• Aetna will make the April PCMH payment on April 17. Going forward, Aetna PCMH payments will be processed on the first Sunday of the month with the payment going out approximately three days after.
• Oklahoma Complete Health will make the April PCMH payment on April 17. Going forward, Oklahoma Complete Health payments will be made the first Wednesday of the month (unless the 1^st of the month is a Wednesday, in which case, payment will be made the second Wednesday of the month).

OHCA will continue to make PCMH care coordination payments for members who are not enrolled in SoonerSelect but who are still eligible to receive services through SoonerCare PCMH.

Please make sure you have submitted your EFT info to the plans.

Provider types:  All Providers

OHCA encourages all health care providers to contract with each SoonerSelect health plan — Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma, Oklahoma Complete Health, and Oklahoma Complete Health for the Children’s Specialty Program — to continue serving all SoonerCare members who have transitioned to SoonerSelect. Contact the health plans for more information on provider contracting.

Visit the SoonerSelect page for contact information, provider directories, benefit guides and member handbooks.

More materials include day one guides, FAQs and other resources that will help you continue to serve members.

Provider types: 017, 110, 111, 112,114, 115, 116, 118, 121, 134, 135, 136, 137,138 

Message: Effective April 1, 2024, due to the transition to SoonerSelect, there will be some important changes to prior authorizations and requirements for completion of the Customer Data Core (CDC). SoonerSelect DMH Contracted and Non-Contracted Providers.pdf (oklahoma.gov)

Provider Types:  27/270-279, 08/081 & 086

Don’t miss this amazing opportunity to hear from our partners DentaQuest and LIBERTY Dental. There is still space available; register using the links below. 

Topics will include but are not limited to continuity of care period, prior authorizations, contracting/credentialing and dental home.

Click here to register for the LIBERTY Dental session at 2 p.m., Tuesday, March 5, 2024.

Click here to register for the LIBERTY Dental session at 10 a.m., Thursday, March 7, 2024.

Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024.

Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024.  

Click here to register for the LIBERTY Dental session at 2 p.m., Wednesday, March 13, 2024.

Provider Types: 08, 09, 10, 31, and 52

Effective Nov. 1, 2023, OHCA has added coverage for psychiatric collaborative care and behavioral health integration services. Coverage and billing information for these services can be found here.

Provider Types: All

OHCA has been working with our SoonerSelect partners to ensure they have an adequate network to serve our SoonerCare members. The health plans may need additional information from our provider community to complete provider files and update provider directories. OHCA is aware of these requests and asks that you work with the health plans by sharing the additional requested information to ensure they have complete and accurate provider information for our members.   

Provider Types:  27/270-279, 08/081 & 086

Description:  Due to unforeseen circumstances the SoonerSelect dental webinar with DentaQuest that was scheduled for 10 a.m., Tuesday, March 5, has been canceled.  Please remove this webinar from your calendar and sign up for one of the remaining sessions.

Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024 

Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024

Long-Term Care PFP Payment Update

TITLE: Nursing Facility Pay for Performance (PFP) Payment Update

Run Date: 2/26/2024 – 3/8/2024

PV Type:  03/ 30,35

SFY 2024 3rd quarter PFP payment will be made on Feb. 28, 2024.

We thank you for your continued service to SoonerCare members.

TITLE: ICF/IID Vocational & Day Services Enhanced Payment -Update

Run Date: 02/26/2024 – 03/08/2024

PV Type: 03/ 31,34

SFY 2024 3rd quarter enhanced payment for vocational and day services will be made on Feb. 28, 2024.

We thank you for your continued service to SoonerCare members.

Provider Types/Specialties: 093, 115, 121, 535, 585, 586, 587

Providers:

This is a reminder that licensed behavioral health provider contracts (type 53 including LADC, LMFT, LPC, LBHP and LCSW) are set to expire Feb. 28, 2024. Contracts that have not had a renewal completed by Feb. 29, 2024, will be unable to submit claims until their renewal has been submitted and approved. OHCA will be unable to prioritize renewals for any provider submitted after Feb. 28, 2024, and all renewals will be processed based on the date received. Failure to complete a renewal will result in the provider being required to submit a new application to become credentialed with SoonerCare.

Provider Types:  27/270-279, 08/081 & 086

Description:  Please join us for one or more sessions presented separately by our dental partners, DentaQuest and LIBERTY Dental. Topics will include but are not limited to continuity of care period, prior authorizations, contracting/credentialing and dental home.

Click here to register for the LIBERTY Dental session at 2 p.m., Tuesday, March 5, 2024

Click here to register for the LIBERTY Dental session at 10 a.m., Thursday, March 7, 2024

Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024

Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024

Click here to register for the LIBERTY Dental session at 2 p.m., Wednesday, March 13, 2024 

Providers: All

Providers and vendors may request consideration for SoonerCare coverage of a new service, procedure, technology, device or other benefit. For your request to be considered, please complete and submit a Request for New SoonerCare Coverage Consideration Form.

Remember to attach any requested supporting documents and any other evidence-based documents you wish to be considered in this review of coverage to the completed form. Completed forms should be submitted by email to massunit@okhca.org.

Investigational, non-FDA approved, experimental or solely cosmetic services will not be considered for coverage. All services must be medically necessary in accordance with OAC 317:30-3-1(f).

Provider Type – All Medical and Durable Medical Equipment Providers

01/010, 012, 014,- 018, 201, 206,  02/020 - 022, 06/060, 08/080 -082, 084, 085, 088, 106, 181, 183, - 186, 188, 192, 194 -199, 202, 203, 208, 801, 802, 09/90-96, 210, 211, 564, 999 10/100-102, 14/140, 18/180, 19/190, 207 22/220, 25/220, 250-253, 277, 28/280-281, 29/290-292, 31/272, 310-338, 340-352, 354-359, 520-529, 540-552, 554-566, 568, 569, 999  

In response to feedback from medical and durable medical equipment (DME) providers about the practical challenges that cessation of retroactive prior authorization (PA) requests causes, OHCA is changing its requirements. 

OHCA will allow retro PA requests to be submitted up to five business days after the first service date.  Please limit your submissions to retro requests of no more than five business days after the first date of service. Requests beyond the five days will be canceled.  

Medical imaging retro PA requests will remain at three business days.

Provider Type – All Dental Providers

021, 086, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 999

In response to feedback from dental providers about the practical challenges that cessation of retroactive prior authorization (PA) requests causes, OHCA is changing its requirements. 

OHCA will allow retro PA requests to be submitted up to five business days after the first service date. Please limit your submissions to retro requests of no more than five business days after the first date of service. Requests beyond the five days will be canceled.  

PV Types: 01, 08, 31, 52

The year-end C-section rate letters for state fiscal year 2023 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.

If you need help to retrieve your letters, please call 800-522-0114.

You may also view the SoonerCare C-section rates and reports available on the Cesarean Reports webpage.

Thank you.

Provider Types: 27/270-279, 08/080-081 & 086

This class will provide you with the tools you need to be successful during the transition and implementation of the SoonerSelect Dental Program. Join us at 10-11 a.m., Thursday, Feb. 8, 2024. Click here to register.

Provider Type: 12/120

Targeted Audience: OHCA-contracted school districts and OHCA providers that provide Medicaid services pursuant to an IEP or IFSP.

OHCA is delaying including school-based and SoonerStart program services in SoonerSelect for the first 15 months from the date of SoonerSelect implementation (April 1, 2024). Through the 15-month extension, school-based and SoonerStart services will be processed and reimbursed through OHCA, maintaining current reimbursement practices. Health and Children’s Specialty Program CEs will reimburse OHCA-enrolled qualified school providers and SoonerStart providers beginning July 1, 2025. If you have any questions regarding this global, please email Lana.Brown@okhca.org.

Provider Types: 27/270-279, 08/080-081 & 086 09/94

All dental providers using CRNA services and/or billing for in-office sedation, other than nitrous oxide, should review the terms and conditions for billing and coding to ensure that you are in compliance with federal regulations, state policies and other guidelines. We strongly encourage a review of your contract language to ensure your coding and billing practices are compliant with documentations standards, policy and other applicable regulations. CRNA services must be billed with the actual servicing provider listed as the rendering provider on the claim, and all rendering providers must have a contract with OHCA (O.A.C. 317:30-3-1(b)). OHCA will soon be providing additional education and clarity on this subject. Until then, please review your coding and practices and align them with required practices and policy.

Provider Types: 27/270-279, 08/080-081 & 086

This class will provide you with the tools you need to be successful during the transition and implementation of the SoonerSelect Dental Program.

Jan 30, 2024, 10:00-11:30 AM. Click here to register.

Provider Types/Specialties: All

The Oklahoma Health Care Authority has raised the FPL threshold for the SoonerPlan program. View the new income guidelines on the OHCA website. This change will expand access to reproductive health services for individuals ages 19 and older who are uninsured or underinsured and do not qualify for these services through other SoonerCare programs.

The goals are to improve outcomes across the State in:

• Healthy birth spacing.
• Infant and maternal mortality and morbidity rates.
• Adolescent health and teen pregnancy prevention.
• Health disparities.

The effective date for the new income guidelines is Jan. 1, 2024.

Provider Types: 27/270-279, 08/080-081 & 086

Effective Feb. 1, 2024, the orthodontic payment structure will change from three yearly bulk payments over a 36-month period to one yearly bulk payment and four quarterly payments over a 24-month period. Dental providers can review information regarding this change by visiting our Provider Training page and viewing the Quarterly Orthodontic Payments document found under Resources.

Provider Type: Dentists 27, 270-279, 08, 080, 081, 086

This is to inform you that the SoonerCare Provider Portal will be able to show if a member is enrolled in the SoonerSelect Dental Program; however, it will not show the dental plan assignment until or after 2/15/2024. Follow the steps below to check member SoonerSelect Dental Program eligibility and identify plan assignment until the Provider Portal is updated.

1. Verify eligibility on OHCA secure provider portal; look for SoonerDental, if not listed, the member remains on traditional SoonerCare so you may continue as usual; if SoonerDental is returned in your results, please continue to Step 2.

2. Verify eligibility with the member’s plan, LIBERTY LIBERTY Dental Plan of Oklahoma  or DentaQuest www.DentaQuest.com via their provider portal. If unable to determine which plan the member is assigned to, ask the member for their ID card, and proceed with contacting their plan.

3. If you are unable to determine eligibility, please call the Provider Helpline at 1-800-522-0114, Option 1 for assistance.

We have an upcoming training for dental provider’s and their staff on January 30, 2024, at 10:00 am., titled “SoonerSelect Dental – Getting Started and Preparedness for Day One”. You may register for training here. We look forward to sharing important information about our SoonerSelect Dental program.

Provider Type: All Medical Providers and All Durable Medical Equipment Providers

01/010, 012, 014,- 018, 201, 206,  02/020 - 022, 06/060, 08/080 -082, 084, 085, 088, 106, 181, 183, - 186, 188, 192, 194 -199, 202, 203, 208, 801, 802, 09/90-96, 210, 211, 564, 999 10/100-102, 14/140, 18/180, 19/190, 207 22/220, 25/220, 250-253, 277, 28/280-281, 29/290-292, 31/272, 310-338, 340-352, 354-359, 520-529, 540-552, 554-566, 568, 569, 999  

Effective Feb. 1, 2024, OHCA will no longer issue retroactive authorizations for medical services or durable medical equipment (DME).

This change applies specifically to prior authorizations submitted via the secure provider portal utilizing the medical radio button.

Authorization processes currently in place for behavioral health services are not included in this change. 

Please submit any outstanding authorization requests (that fall within the currently allowed retroactive date timeframe) for retroactive authorizations no later than close of business on Jan. 31, 2024.  A complete request must be submitted by close of business Jan. 31, 2024 to avoid cancellation.

Provider Type: All Dental Providers

021, 086, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 999

Effective Jan. 27, 2024, dental services will no longer be authorized retroactively. Services that require a prior authorization must be requested and approved prior to rendering.

All requests for outstanding retroactive dental services must have a complete request submitted by close of business Jan. 26, 2024, to avoid cancellation.

The Office of the State Coordinator for Health Information Exchange (HIE) and State-Designated Entity, MyHealth Access Network, invite participants to a virtual speaking engagement. The webinar will provide an overview of the purpose, framework and coverage of the HIE, the approved emergency rules surrounding broad based exemptions, connection fee assistance, and provider incentive directed payments for those who connect and utilize the HIE. These directed payment incentives can result in a significant reimbursement increase for the provider types listed below.

Providers eligible for the directed payments include advanced practice nurses, mid-level practitioners, mental health providers and licensed behavioral health practitioners¹, podiatrists, physicians², and anesthesiologist assistants.

Click here to register for the Oklahoma Health Information Exchange (HIE) Updates webinar from 11 a.m.-12:30 p.m., Wednesday, Jan. 24, 2024.

¹Behavioral health services by mental health professionals and licensed behavioral health practitioners at community mental health centers are excluded as they participate in a separate directed payment program.

²Services rendered by state employed or contracted physicians are excluded as they participate in a separate directed payment program.

Provider Type/Specialty: All

Provider Types/Specialties: Primary care and pediatric providers doing well-child checks

The Oklahoma Health Care Authority is presenting a webinar for SoonerCare providers on Tuesday, Jan. 16. The Quality Improvement Fluoride Varnish (QIFV) project is aimed at increasing the use of fluoride varnish for children in medical clinics, decreasing the incidence of dental caries in SoonerCare children, and improving the overall health of SoonerCare kids.

Visit the OHCA Provider Training page to register to attend the QIFV webinar from 2-3:30 p.m., Tuesday, Jan. 16. After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify SoonerCareEducation@okhca.org to cancel their registration.