2010 Global Messages

Posted
Date

Subject

Message

TITLE: Humidifiers Used with Positive Airway Pressure Device

RUN DATES: 12/28/2010 – 02/13/2011

PV TYPES: 25, 250 - DME

Attn:  All Insure Oklahoma DME providers

As of 1/1/11, procedure codes E0561--E0562  HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE will no longer have co-pay for Insure Oklahoma Individual Plan (O-EPIC) members.  Since humidifier is always attached to a pap machine, this is to prevent the double co-pay on a DME equipment item that comes as one item, but is billed as two procedure codes.

Title: CPT Code 92283, Color Vision Examination

Run Date: 12/20/2010 – 02/05/2011

PV Types:  18 – Optometrist, Spc:  180 – Optometrist, 330 – Opthamologist

Effective 01/01/2011 CPT code 92283 (Color Vision Examination, Extended EG Anomaloscope or Equivalent) requires an Attachment with a copy of the test results AND documentation of medical necessity.

Routine color vision testing is part of a routine exam when indicated. CPT code 92283 requires special testing equipment and has very limited application.

Title: OnLine Enrollment: NODOS/Application/eNB1

Run Dates: 12/15/2010 – 01/31/2011

PV Types: 01 - Hospitals

The transition for Online Enrollment has gone reasonably well. One exception is the process related to pregnant women and newborns.  The Notice of Delivery of Service (NODOS), Home View application, and the Electronic New Born process (eNB1) are the forms in question.

CLARIFICATION: The NODOS replaces the function of the MS-MA-5 and should be done upon admission if the delivering mother shows no Medicaid eligibility. AFTER the NODOS is done, the Home View Application may be used to make the full Medicaid application for persons who do not show active Medicaid status. The eNB1 should be used to add all children to an existing case which includes the mother. 

DO NOT use either the NODOS or the Home Application to add newborn children to a mother who has existing eligibility.

Title: MedSolutions Radiological PA Requests

Run Date: 12/14/2010 – 01/31/2011

PV Types: 31 – Physicians, 52 – OU/OSU State Physicians, 01 – Hospitals, 341– Radiologists

Revised

MedSolutions manages the OHCA radiology program as noted in Provider Letter OHCA 2010-48, and Banner message #442.

Effective January 01, 2011, requests for prior authorized radiology services submitted directly to OHCA will not be processed.

All CT, MRI and PET requests for prior authorization must be submitted to MedSolutions through either their secure internet web portal http://www.medsolutionsonline.com/ or faxed toll-free at 1-888-693-3210.

For telephone inquires, call MedSolutions toll-free at 1-888-693-3281.

Title: SBIRT Behavioral Health Service

Run Date: 12/15/2010 – 01/31/2011

PV Type: 31-Physicians, 52-State Employed Phys

MESSAGE:

Effective with January 1, 2011 dates of service when billing SBIRT (screening, brief intervention, referral for treatment) behavioral health service please use CPT code T1023.

This code will replace 99408, 99409. Claims billed with these two codes will deny after January 1, 2011. 

If you have any questions please contact provider services at 1-877-823-4529 option #2.

Thank you for your continued support of our SoonerCare members.

Title:  GO GREEN OKLAHOMA update

Run Date: 12/02/2010 – 01/17/2011

PV Types: All

The Oklahoma Health Care Authority is pleased to announce that we will implement a “Green” provider letter process soon. Tentatively effective February 1, 2011 provider letters and notifications will be sent via email. As part of our participation in the “Go Green Oklahoma” initiative, our goal is to reduce our carbon footprint by minimizing the number of provider paper notifications we print and mail.

Testing will begin December 15, 2010 and continue periodically through January 2011. Please login to the secure site to verify and/or update your current email and contact information to ensure that you do not miss valuable information. Notifications by fax blast will be an option for those providers receiving and/or submitting paper claims, billing, and/or remittance advice.

We are very excited about this new process and look forward to working with you.

If you have any questions or concerns, please contact the Provider Services department at (877)823-4529, option 2.

Title: Signed Parental Consent Form

Run Dates: 11/16/2010 – 01/01/2011

PV Types: 17 – Therapist
   087 – Therapy Clinic
   170 – Phys Ther
   171 – Occ Ther
   172 – Resp Ther
   173 – Speech Ther
   174 – Occ Ther Assist
   175 – Phys Ther Assist

Effective January 1, 2011, all therapy providers requesting Physical Therapy, Occupational Therapy, and/or Speech Therapy services must obtain a signed and dated parental consent form from parent or guardian, prior to evaluation and services being rendered. 
Any prior authorization requests submitted without a signed and dated parental consent form will not be processed.
Please remember to submit all prior authorizations with the revised HCA-12A and HCA-13A, including all documentation to support medical necessity.

Title: Integrity of Provider Accounts

Run Date: 12/15/2010 – 01/01/2011

PV Types: All

REMEMBER: Always safeguard the integrity of the provider
account by revoking a user’s access when a staff member
leaves your organization!

For additional assistance, please contact the Internet Help Desk at (800) 522-0114, option 2, then 1.

Title: GO GREEN OKLAHOMA Initiative

Run Date: 11/15/2010 – 01/01/2011

PV Types: All

The Oklahoma Health Care Authority is pleased to announce that we will soon be implementing a “Green” provider letter process. Effective, Feb. 1, 2011, provider letters/
notifications will be sent via email. In participating in the “Go Green Oklahoma” initiative our goal is to reduce our carbon footprint by minimizing printing and mailing provider paper notifications.

To date more than 95 percent of provider billing and payment is completed online.  Our goal is to establish consistency across the board with all provider practices by establishing a process that allows information regarding provider updates to be accessible and readily available to you instantaneously by the click of a mouse.

In moving forward with these changes we ask that you please login to the secure site to verify and /or update your current email and/or contact information.  Fax blasts notifications will be an option for those providers receiving and/or submitting paper claims, billing, and/or remittance advice.

We are very excited about this new process and look forward to working with you.

TITLE: Changes to school based fee schedule

RUN DATE: 11/10/2010 – 12/25/2010

PV TYPES: 12 / 120

Effective November 1, 2010 the School Based Fee Schedule has changed in regards to speech and physical therapy evaluations and therapy sessions.

Review the updated fee-schedule on the OHCA website at   /content/sok-wcm/en/okhca/providers/school-based-services

Title:  Tiered Reimbursement to PRTFs
Run Dates: 10/22/2010 – 11/30/2010
PVs:   013 – Residential Treatment Center
   033 – Residential Care Facility

Effective immediately, the OHCA is suspending reimbursement to PRTFs utilizing the tiered reimbursement methodology pending further analysis.  Until further notice, PRTFs will be reimbursed according to the rates listed below that were in effect prior to the tiered reimbursement methodology less 3.25%.  The 3.25% reduction was an across the board budget cut for all provider types effective April 1, 2010. 
-------------------------------------------------------------

We thank you for your commitment to quality and our SoonerCare members and apologize for any inconvenience in this matter. If you have any questions please contact Debbie Spaeth, Behavioral Health Director at Debbie.Spaeth@okhca.org, or Jolene Ring by phone at (405) 522-7446 or by email at Jolene.Ring@okhca.org.

Title: Clarification: Online Enrollment/ Claims Submission

Run Date: 10/19/2010 – 12/05/2010 

PV Type: All

Eligibility for members that have used the Online Enrollment application does NOT affect the claims submission process. Although member IDs may now have an alphanumeric number, these claims should continue to be treated the same as all SoonerCare claims. They can be submitted electronically, through the web and on paper. The same fields that have always been required are still required. The Billing Manual has not changed.

If you  do submit a paper claim for services, please verify the mailing address. The mailing address for paper claims has not changed.
Do NOT send claims and/or questions regarding claims, regardless of the member identification number, to the SEU mailbox (P.O. Box 548804). This is for member applications only, NOT CLAIMS data.

Title:  Required Prior Authorization re: Outpatient CT Scans

Run Dates:  October 11 – November 26, 2010

PV Types:  Physicians  3, Hospitals  01, Radiologists 341

MESSAGE:

All outpatient CT services performed on or after November 1, 2010 will require referring providers to submit prior authorization (PA) requests to MedSolutions, an OHCA partnership in managing diagnostic radiologic services. MRI and PET scan services already require prior authorization. Please refer to Provider Letter OHCA 2010-48 for further explanation.

PA requests are to be submitted through the MedSolutions secure internet web portal:  www.medsolutionsonline.com, or faxed toll-free at 1-888-693-3210. For telephone inquires, MedSolutions’ toll-free number is 1-888-693-3281.

Thank you for the quality of care that you provide to SoonerCare and Insure Oklahoma members. If you have questions, please contact the OHCA Provider Services Department at 1-877-823-4529 option #2, or, visit our website at www.okhca.org/radiology.

Title: Dental Information

Run Date: 10/01/2010 – 11/15/2010

PV Types: 27; spc 086, 271, 272, 273, 274

Message:

1)  Please note that there is a new fax number for Dental
    Services:  405-530-7178.  Please use this number for
    all Dental Prior Authorization [PA] CHANGE OF PROVIDER
    Requests, OHCA form DEN-3.  This form can be found at:
    www.okhca.org.

2)  Dental Services has issued a revised Referral for
 Orthodontic Treatment Form, DEN–2, found at
 www.okhca.org.

Title:  Changes to Paper Warrants

Run Dates: 09/27/2010 – 11/11/2010

PV Types: All

Starting October 1st SoonerCare Providers who receive paper warrants for payment of claims will see a difference in the appearance of their checks. OHCA is implementing new security features to protect your payment.

The traditional blue check is being replaced with a multi- color check in shades of red and blue. You will now see a border at the top of the check which advises the bank teller to look for the multi-color background.

Additionally, there is a watermark that says VOID if the check is copied or scanned in any way.

Title: 2010 Fall Training Update

Run Date: 09/24/2010 – 10/28/2010

PF Type: All

PLEASE JOIN US FOR THE 2010 PROVIDER FALL WORKSHOPS!!

Providers who attend will receive beneficial information concerning SoonerCare policies and programs, the Electronic Health Record Incentive and much more!

Registration for the Tulsa workshop is now closed, however, walk-in registrations will be accepted each day of training.  Online registration is still available for Lawton, October 14th; and Oklahoma City, October 26th – 27th.

REMINDER: Click the “Submit Registration” button to finish your registration. You will then receive your confirmation e-mail which will include the physical location of the workshops as well as your selected classes and times.

REGISTER TODAY!
Information and registration is available at: /content/sok-wcm/en/okhca/providers/provider-training

Title: 2010 Fall Training Update

Run Date: 09/16/2010 – 10/28/2010

PF Type: All

PLEASE JOIN US FOR THE 2010 PROVIDER FALL WORKSHOPS!!

Providers who attend will receive beneficial information concerning SoonerCare policies and programs, the Electronic Health Record Incentive and much more!

Registration for the Durant workshop is now closed, however, walk-up registrations will be accepted the day of training.  Online registration is still available for Tulsa, September 29th - 30th; Lawton, October 14th; and Oklahoma City, October 26th – 27th.

REMINDER: Click the “Submit Registration” button to finish your registration. You will then receive your confirmation e-mail which will include the physical location of the workshops as well as your selected classes and times.

REGISTER TODAY!

Information and registration is available at: /content/sok-wcm/en/okhca/providers/provider-training

Title: Clarification – OnLine Enrollments for Newborns

Run Date: 09/10/2010 – 10/25/2010

PV Type: All

This message is generated to clarify the process to be used for Newborn Enrollment purposes.

Please continue to use the eNB-1 application to add newborns to EXISTING cases.

Neither the Online Enrollment, nor the “Notification of DOS (NODOS) application”, is to be used to add newborns to existing cases.

If there is no existing case and the individual presents at the hospital without insurance coverage, the hospital may complete an online “Notification of Date of Service (NODOS)” form and submit it. This will hold the application date for 15 days.  This electronic process replaces the MS-MA-5 functionality. 

If the facility is able to complete the entire Online Enrollment application and the applicant is eligible, they will receive an ID number in real-time. This number can be used to bill a claim for services.

Title: CPT Code 69714

Run Dates: 09/09/2010 – 10/24/2010

PV Type: 20 - Audiologist, Spc:  200 – Audiologist, 182 – Hearing Clinic

Message:

Effective October 1, 2010 CPT code 69714 [Osseo integrated implant, temporal] will require a prior authorization.  All requests must be submitted with the revised HCA-12A, HCA-13A along with documentation to support medical necessity. Documentation must also address: why traditional amplification does not work; specify if an Audiogram has been done within last 6 months; and, testing noise documentation.

Title: New Recipient Identification Numbers (RID)

Run Date: 09/09/2010 – 10/24/2010

PV Types: All

Message:

SoonerCare applicants began utilizing OHCA’s new Online Enrollment process on September 7, 2010.

NEW Members who utilized the new Online Enrollment process are issued a Recipient Identification Number (RID) which begins with the letter “B” and followed by eight numbers. This newly formatted RID will be shown on the member identification card.

Please note that this change affects only NEW members who utilize the Online Enrollment process. Current members will retain their original RID (nine numerical digits).

All payments, including pharmacy, will process for this new styled number as well as for the original numbers.

We apologize for any confusion this change may have created. Thank you for your continued participation in the SoonerCare Program.

Title: Attention: Hospitals using the Newborn [NB1] Application

Run Date: 09/01/2010 – 09/15/2010

PV Types: 01 – Hospitals

MESSAGE:

The OHCA secure website will be undergoing maintenance beginning Friday, 09/03/2010 at 5:00 pm until Tuesday, 09/07/2010 at 7:00 am. The Newborn [NB1] application will be unavailable during this time.

OHCA is preparing to go-live with SoonerCare online enrollment. If you wish to assist your clients with SoonerCare enrollment you can access www.mySoonerCare.org and submit applications beginning September 7th.

Title: Treatment Plan for Private Duty Nursing Authorization Requests

Run Date: 08/26/2010 – 10/10/2010

PV Types: 05 – Home Health Agency, Spc: 050 – Home Health Agency, 051 – Specialized Home Nursing Svs

Prior Authorization requirements for Private Duty Nursing Services: Authorizations require a current treatment plan for the member, signed by the member’s attending Physician.

Effective immediately, a signed copy of current 485-Plan of Care (Home Health Certification) or Plan of Care must be included in the initial authorization request for private duty nursing services, along with the HCA-12A, HCA-13A and letter of medical necessity for all initial authorization requests. A copy of current 485-Plan of Care will be required every 60 days, per current amendment process to continue the authorization for private duty nursing services.

Title:  Correction to OHCA 2010-07: re Occupational Therapy Svs

Run Date: 08/30/2010 – 10/13/2010

PV Types: OT/PT, 01 - Hospital, 17 – Therapist, 170 – Physical Therapist, 171 – Occupational Therapist, 174 – OT Assistant, 175 – PT Assistant, 336 – Physical Medicine & Rehab Practitioner

Please note the following correction to OHCA 2010-07, dated 02/12/2010, Dear Provider Letter, paragraph 5: “…when this service is rendered in an outpatient hospital-based facility, the claim should be submitted on a UB claim form with both the revenue code 420 (PT) or 320 (OT) and the CPT code 97542…”

Please note that the correct revenue code for OT is 430. The 320 (OT) revenue code is incorrect.

We apologize for any inconvenience this may have caused. Thank you for your continued services to Oklahoma’s SoonerCare Members.

Title: 2010 Fall Training

Run Date: 08/26/10-10/31/10

PF Type: All

PLEASE JOIN US FOR THE 2010 PROVIDER FALL WORKSHOP!!
Providers who attend will receive beneficial information concerning SoonerCare policies and programs, the Electronic Health Record Incentive and much more!

REGISTER TODAY!
Information and registration is available at: /content/sok-wcm/en/okhca/providers/provider-training

REMINDER: Click the “Submit Registration” button to finish your registration. You will then receive your confirmation e-mail which will include the physical location of the workshops as well as your selected classes and times.

The first stop on the 2010 Fall Training calendar is Durant, OK on September 21st, followed by: Tulsa, September 29th - 30th; Lawton, October 14th; and, will conclude in Oklahoma City, October 26th – 27th.

Title: Electronic Remittance Advice (ERA) files for August 18, 2010

Run Date: 08/24/2010 – 11/24/2010

PV TYPES: All

ATTENTION:

All providers that receive the 835 Electronic Remittance Advice

MESSAGE:

Please be advised that all ERA files for warrant date August 18, 2010 will be re-generated and re-posted. This action is necessary as formatting issues with several ERA files contained errors or missing information. Re-posting these ERA files DOES NOT affect the warrant or check amount for August 18th.

If you have any questions, please contact the EDI Department at 405-416-6801.

Title: Mass Adjustment – Region 52

PV Types: All

Run Date: 08/19/2010 – 10/04/2010

Message:

OHCA is processing a mass adjustment that will be reflected on provider’s remit throughout the month of August. The ICN will start with a 52. This adjustment was done to correct claims with the fee schedule updates that were to occur on 07/01/2010.

Unfortunately, not all rates were updated prior to 7/1/2010 so some claims processed incorrectly. 

Over 430,000 claims have been reprocessed. Some claims have paid more, some claims have paid less and there have been no changes to some claims.

We apologize for the inconvenience this has caused.

Title: Accreditation Clarification Deadline 01/01/2011

Run Date: 08/19/2010 – 10/31/2010

PV Types: 250 – DMEPOS Suppliers

Message:

If your company is currently accredited by an approved Accreditation organization, you may submit a copy of your certificate at the time of contract renewal.  You will be notified of the contract renewal period during the Fall of 2010.   All DME contracts must be renewed by January 31, 2011.

It is not necessary to submit the accreditation certification at this time.
Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org

Title: Sterilization Consent Forms

Run Date: 08/04/2010 – 09/19/2010

PV Types: 01, Hospital, 02, ASC, 08, Clinic, 31, Physician

Message:

Pursuant to 42 CFR §441.2455, every sterilization requires that a consent form must be signed at least thirty days prior to the actual procedure, with few exceptions.  The consent form expires one hundred and eighty days following signature.  These forms are required to be filed with both the hospital and physician claims.  We have also recently added Spanish versions of this form for your use on our website.

It is imperative for all providers to understand that the consent forms must be signed at least 30 days prior to the actual sterilization or that the physician attests that it meets one of the allowable exceptions as noted on the form.  The Oklahoma Health Care Authority will deny claims in which the consent form was not signed at least 30 days prior to the procedure.

Title: Revision/Clarification: Authorization for 92526

Run Dates: 08/10/2010 – 09/25/2010

PV Types: 17  – Therapist, Spc:  170 – Phys Therapist, 171 – Occupational Therapist, 173 – Speech/Hearing Therapist, 174 – Occup Ther Asst, 175 – Phys Ther Asst, 182 – Speech/Hearing Clinic

Revision/Clarification:

When requesting authorization for 92526, if the member has a current occupational or speech therapy please submit an amended PA with supporting documentation and appropriate modifier for the service requested. Please note the 30-day retroactive rule applies.

Title: Individually Contracted SC LBHP’s contracted as a Group Practice member

Run Date: 07/29/2010 - 09/17/2010

PV:  Type: Mental Health Pv – 11, LBHP - 53, Spc:  LMFT –  585, LADC – 586, LCSW – 115, Lic Psych – 112, LBP - 535, LPC - 121

Message:

RE:  Individually Contracted Sooner Care Licensed Behavioral Health Providers (this includes LMFT, LCSW, Licensed Psychologists, LBP, LPC, and LADC) who are contracted as a member of a Group Practice. 
   
Prior Authorizations - Use ONLY your individual provider ID number for ALL CDC submissions, Notification of CDC Submissions and any other authorization submissions to APS Healthcare, Inc.  DO NOT use your Group ID.
 
Claims Submissions - Use your Group ID number in the "billing provider" field and your Individual ID number in the "rendering provider" field. 
 
**Existing Authorizations under your Group ID will need a correction request faxed into APS asking for the authorization to be changed to your Individual Provider ID number.  Be sure to include what that number is.**

Title: PA Requirements for Wheelchair Accessories

Run Date: 07/27/2010 – 09/30/2010

PV Types: SPC 250

Message:

Effective with dates of service after August 1, 2010, the Prior Authorization requirements for Wheelchair Accessories have been added. Please see list of HCPCS codes affected at the Durable Medical Website at
www.okhca.org. /content/sok-wcm/en/okhcaproviders.aspx?id=594&menu=74&parts=7669

Title: Request for Medical Authorizations

Effective 08/15/2010

Run Dates: 07/21/2010 – 09/06/2010

PV Types: All

Message:

Effective August 15, 2010 the Medical Authorization unit will only process prior authorization submissions that utilize the 09/02/2009 revised Form HCA-12A.  Any prior authorization requests submitted with outdated HCA-12A forms will not be processed. 

Please remember to submit all prior authorizations with the revised HCA-12A, HCA-13A and CMN if applicable and all required medical necessary documents.

Title: Update: OHCA Letter 2010-41 – ADM Referrals

Run Date: 07/20/2010 – 09/05/2010

PV Types: All

You recently received OHCA letter 2010-41 concerning Administrative Referrals for Specialty Services. The contact information for your requests was inadvertently omitted from the referral form SC-14. This information has been updated to reflect the appropriate telephone and fax numbers for your requests. 

Specialty service providers who are unable to obtain a PCP referral and are requesting consideration from OHCA should begin using the SC-14 form now. All prospective requests are currently reviewed for medical necessity. Retrospective requests will also be reviewed for medical necessity in the near future. Beginning Sept. 1, 2010 documentation of medical necessity will be required for all retrospective administrative referrals.

Title: MHSAS Member Eligibility - Clarification

Run Date: 07/20/2010 – 09/05/2010

PV Types: All

Message:
Eligibility status of MHSAS has been added to the OHCA Member Eligibility Verification file on the OHCA Secure Site.
This is an additional benefit which covers Mental Health and Substance Abuse services only for those who meet the medical necessity and other requirements to be seen by an ODMHSAS contracted agency.
Questions please contact: erin.meyer@okhca.org

Title: Dental Authorization Requests – Mailing Address

Run Date: 07/19/2010 – 09/05/2010

PV Types: 27;  spc 271, 272, 273, 274

Message:

Effective immediately, please mail all Dental Authorization requests to: 

OHCA Dental Unit
2401 N.W. 23rd Street/ Suite 1-A,
Oklahoma City, Oklahoma  73107

Title: School Based Billing Rates

Run Date: 07/16/2010 – 08/31/2010

PV Types: 12 – School Corp, Spc:  120 – School Corp

Message:

Effective 7/1/2010 School-Based billing rates have changed.

Review the updated fee-schedule rates on the OHCA website at /content/sok-wcm/en/okhca/providers/school-based-services

Title:  Fee Schedule Update

Run Date:  07/08/2010 – 08/22/2010

PV Types:  All

Please note the following additional information related to the below listed Global Message posted 06/29/2010.

1. When the Fee Schedule was updated, this update included elimination of consultation codes. Please use the appropriate E&M CPT code based on the service provided.
2. If you have any questions, please contact the HP Call Center at (800) 522-0114.
--------------------------------------------
Original Message to all Providers: This is our annual reminder that we rebase our fee schedule effective July 1 of each year. This allows us to incorporate all Medicare fee schedule changes and follows our current approved methodology. The previously approved rate cut of 3.25% is still in effect.

Title: Outpatient Behavioral Health Claims

Run Date: 07/07/2010 – 08/21/2010

PV Types: 11, spc:  110, 111, 118

Message:

Currently, when submitting a claim for outpatient behavioral health services, providers are receiving a denial message stating that a service/code requires ‘manual pricing’.

OHCA is researching this claims processing issue and hopes to have this it corrected as soon as possible.

OHCA will notify you once the system is set up to correctly process your claims so that you can submit claims or void off and refile your claims that have denied for this error code.

Please do not call the helpline referencing this issue as they cannot assist you with this problem.

Thank you for your continued support and services. 

Title: ODMHSAS Contracted Providers

Run Date: 07/05/2010 – 08/20/2010

PV Types: SPC 118 – Mental Health, ODMHSAS

Message
As a reminder to ODMHSAS contracted providers, until your ODMHSAS contract/budget has been returned and set up, all claims for ODMHSAS-only services will be denied. It is recommended by ODMHSAS that providers not submit claims until this part of the contract/budget process has been completed.

Claims which have been submitted and are in a denied status do not need to be resubmitted at this time, and you do not need to call about these denials. It is strictly a ODMHSAS contract/budget issue at this time.

Any questions related to your ODMHSAS contract status should be directed to the ODMHSAS Helpdesk at helpdesk@odmhsas.org.

Thank you.

To all Providers

This is our annual reminder that we rebase our fee schedule effective July 1 of each year. This allows us to incorporate all Medicare fee schedule changes and follows our current approved methodology. The previously approved rate cut of 3.25% is still in effect. If you have any questions please contact provider services at 1-877-823-4529.

Title: DMEPOS Accreditation Deadline January 1, 2011

Run Date: 07/01/2010 – 09/30/2010

PV Type:  250- DMEPOS Suppliers

Message:

Effective January 1, 2011, all suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) must be accredited by a Medicare deemed accreditation organization for quality standards for DMEPOS suppliers to bill the SoonerCare Program in accordance with OHCA Policy 317:5-210 (revised 11/1/07). 

This accreditation requirement includes all Home and Community Based Services (HCBS) waiver providers as well unless otherwise noted below.

Providers that provide the following products exclusively are exempt: 1. Personal Emergency Response Systems; 2. Architectural Modifications; 3. Vehicle Adaptations 
The Medicare deemed accreditation organizations list can be located at /content/sok-wcm/en/okhcaproviders.aspx?id=594&menu=74&parts=7669
Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org

Title: Edit 5014

Run Date: 06/08/210 – 07/23/2010

PV Type: 01, 010, 011, 012, 014

Message:

OHCA processed a mass adjustment on June 3, 2010 to correct claims that were paid in error related to edit 5014.  This edit is for outpatient hospitals claims to prevent more than one outpatient hospital claim for the same patient and the same date of service from paying to the same facility.  The edit was inadvertently turned off for claims billed and paid between February 28, 2010 and May 18th, 2010.  If you have received payment on more than one outpatient claim for the same patient and the same date of service, your monies may be recouped.  You will receive this information on a subsequent remittance advice. 

We apologize for the inconvenience.

Title: 3rd Quarter DSH Payments

Run date: 06/08/2010 – 07/25/2010

PV Types: 01; 010, 011, 012, 014

Message:
The 3rd quarter FFY10 DSH payment has been processed and will be issued on provider’s 6/16 remit.

Title: Admission Claims

Run Date: 05/11/2010 – 06/25/2010

PV Type: 01 – Inpatient Facilities

Message:

When notified by APS that medical records are necessary to evaluate a claim, please submit these records timely.

If you wait until the payment has been recouped before you send records you must submit a new claim for your records to be reviewed.

Title:  Billing Same DOS on the Same Claim/Edit 5017

Run Date: 05/10/2010 – 06/25/2010

PV Types: 31, Physician 52, State Employed Physicians 10, Mid-level Practitioner 09, Advance Practice Nurse 25, DME/Medical Supply Dealer

Message:
We have modified our claims processing system to edit claims for like-providers only. This means provider claims will edit against other provider claims and DMEPOS claims will edit against other DMEPOS as opposed to all claims.

We have backdated this change to 1/1/2010. If you have specific questions please call Provider Service at 1-877-823-4529, Option 2.

Title: E&M Codes

Run Date: 05/04/2010 – 06/19/2010

PV Types: All

A new edit was implemented January 1, 2010 that looked at E&M codes and how they were billed. The system was set to look at the billed date. This caused claims to deny if the new patient appointment was billed after the follow-up appointment. The system has been modified to process the claim based on the date of service. This change is effective today, May 4, 2010. You can correct any previously denied claims for DOS January 1, 2010 and after.

Please call Provider Services at 1-800-522-0114 if you have any questions.

Your comments helped us realize we needed to review our process. Thank you and we apologize for the inconvenience this may have caused.

Title: DMEPOS Rate Change – A4215 – Needle, sterile, any size, each

Run Date: 05/04/2010 – 06/30/2010

PV Type: 240 – Pharmacy;

250 DME/Medical Supply Dealer

The rate for HCPCS Code A4215 (Needle, sterile, any size each) has been adjusted from $0.89 each to $0.42 each effective May 1, 2010. This rate includes the 3.25% Provider rate reduction in effect. 

Title: New HCA12 form - Implementation Postponed

PV TYPES: All

Run Dates: 05/03/2010 – 06/18/2010

Message:

Please note that the implementation of the new HCA12 form that was previously posted on the OHCA prior authorization site has been postponed until further notice.

All providers will need to continue to use the HCA13A form when submitting prior authorizations until further notice.

Title: Registration for Lawton Spring Training

Run Date: 04/29/2010 – 05/11/2010

PV Types: All

Message:

Registration for the Lawton workshops will close next Tuesday, May 4th. The Lawton workshop will be held on May 12th and walk up registration will be available.

Oklahoma City workshops (May 19th & 20th) and Tulsa workshops (May 25th & 26th) will remain open until one week prior to the workshops.

Please register today!

Title:  Edit 5017

Run Dates: 04/27/2010 – 06/12/2010

PV Types: DME – 25; 250

Message:

Thank you for your comments related to edit 5017. We are modifying our system logic to address some of the claims processing concerns you experienced. These changes will be effective within the next three weeks.

Until these changes go into production if you provide two separate services on the same day, i.e. a DME service and a non-DME service, please file your DME claim first. Filing the DME claim first will allow you to bill the other services and not be exposed to the 5017 edit.

We apologize for any inconvenience this has caused.

Title: BRCA Testing

Run Date: 04/22/2010 – 06/05/2010

Pv: Labs: 28, Independent Lab: 280, Mobile Lab:  281, Oncologists:  329
  
Message:
Effective May 1, 2010, the maximum number of units allowed for the following procedure codes will be reduced to 25 units per day.

83898- Molecular diagnostics; amplification, target, each nucleic acid sequence   
 
83904- Molecular diagnostics; mutation identification by sequencing, single segment, each segment

83909- Molecular diagnostics; separation and identification by high-resolution technique (e.g., capillary electrophoresis)     

Please note: The OHCA does not currently reimburse for BRCA 1 or BRCA 2 screening.

Title: Dental Procedure Code D0140

Run Date:  04/20/2010 – 06/05/2010

PV Type:  27 – Dentist, Spc:  86 – Dental Clinic, 271 – General Dentistry, 272 – Oral Surgeon, 273 – Orthodontist, 274 – Pediatric Dentist

Message:
Dental Procedure Code D0140 no longer requires a tooth number on your claim, effective 1-1-2010.

Title:  EP Survey: Next Step

Run Date: 04/08/2010 – 05/23/2010

PF Type: All

As a contracted SoonerCare provider, you may qualify for health information technology incentive payments under a new Medicaid electronic health record (EHR) Incentive Program. Federal legislation designates that cost reimbursement money be made available to certain providers who adopt, enhance, or upgrade EHR technology. Please take a few minutes to visit OHCA’s public website at /content/sok-wcm/en/okhcaEHR-incentive and complete a brief survey. Your input will provide the information needed to make incentive funds available to SoonerCare providers and create a successful program.

Title:  2010 Spring Training

Run Date: 04/08/2010 – 05/27/2010

PF Type: All

Please join us for the 2010 Spring Workshops! Providers who attend will get up-to-date beneficial information on the SoonerCare programs. 

Register today!

Information and registration is available at: /content/sok-wcm/en/okhca/providers/provider-training

Durant, OK will be the first stop on April 27th followed by: Lawton, May 12th; Oklahoma City, May 19th – 20th; and, conclude in Tulsa, May 25th - 26th.

Title: Co-Pay Increase & Provider Rate Reduction

Run Date: 03/26/2010 – 05/10/2010

PV Types: All 

Effective April 1, 2010, all provider rates will reflect a 3.25% across-the-board rate reduction. The updated fees will be available on your personal secure website.

Also starting April 1, 2010, co-pays for non-pregnant adults in SoonerCare (age 21 and older) will be as follows:

$10.00 per day for inpatient hospital stays with a maximum total of $90.00 per hospital stay.

$3.00 for most office and home visits. This includes visits with members’ PCP, optometrists, home health agencies, durable medical equipment providers and outpatient behavioral health providers.

For prescription drugs, there is no co-pay for preferred generic prescriptions. A list of the Zero Copay Drug List can be found at www.okhca.org/providers/rx.

There will be a $2.00 co-pay for prescriptions that cost up to $29.99 and a $3.00 co-pay for prescriptions that cost $30 or more.

Title: School Based Training

Run Date: 03/22/2010 – 04/07/2010

PF Type: Type 12 ; Specialty Type 120

School-Based Training is scheduled for the following dates:

April 1, 2010 – McAlester, OK
April 6, 2010 – Oklahoma City, OK

Please Register for training through OHCA website at:
/content/sok-wcm/en/ohca/schoolbased

Title: Update: Forms & Documentation for PA Requests re HROB Svs

Run Date: 03/04/2010 – 04/19/2010PV

Type: All

Message:

This is an update to Provider Letter OHCA-2007-52, Item 3, which states “The MFM completes and signs the High Risk OB Treatment Plan / Prior Authorization (PA) Request (CH-17) and submits the following documents to the OHCA Medical Authorization Unit for prior authorization…”
Update: It is the requesting provider’s responsibility to complete the High Risk OB (HROB) Treatment Plan / Prior Authorization (PA) Request (CH-17), whether the requestor is the primary OB provider or the Maternal Fetal Medicine (MFM) specialist.  The requesting provider then submits the following documents to the OHCA Medical Authorization Unit for prior authorization: HCA-13A (PA Coversheet), CH-17 (both available on the OHCA website) and a comprehensive prenatal assessment.  If the member is being co-treated by both a primary OB provider and an MFM, the OB provider should complete and submit the HROB Treatment Plan (CH-17), along with a copy of the MFM consultation and recommendations.
For questions regarding this update: (800) 522-0114 or (405) 522-6205.

Title: Batch 270/271 Submitters & Receivers – Redetermination Date Changes

Run Date: 03/04/2010 – 06/30/2010

PV Types: All

Message:
Beginning March 20th, 2010, the 271 Eligibility Response will no longer return a Redetermination Date for inactive clients in the Subscriber Eligibility/Benefit Date segment in Loop 2110C.

Please make any necessary modifications to your system to handle this change.

For any questions, please contact the EDI Help Desk at (405) 416-6801.

Title: PA requests with Photo Documentation

Run Date: 02/25/2010 – 04/08/2010

PV Types: All

Message:

To ensure timely review of Prior Authorizations that require photo documentation effective March 8, 2010 Prior Authorizations for these service must include either a CD of the photographs or a copy of the original photographs. These photos must be appropriately taken and adequately clear to demonstrate medical necessity. Original photographs, CD’s or other media items will not be returned.

Faxed copies of photographs will not be accepted.

Title: PA Process for Diabetic Strips and Lancets

Run Date: 02/25/2010 – 04/08/2010

PV Types:  31 - Physician

322 - Endocrinologist/Internist, 318 - PCP’s (G.P.), 328 – OB/GYN, 250 - DME

Message:

The Prior Authorization (PA) process for diabetic strips and lancets has changed. Effective April 1st, 2010, members can receive 100 strips and 100 lancets per month without Prior Authorization. Requests for more than 100 strips and 100 lancets per month will require Prior Authorization for both children and adult SoonerCare Members. The following documentation is required for a 6-month PA: HCA13A, HCA12A, signed prescription indicating number of times member is testing per day, objective documentation from the last 6 months to support medical necessity for testing frequency, and a copy of the member’s current blood glucose log showing one month’s testing results.

Title: DMEPOS Advisory Committee (DAC)

Run Dates: 2/23 /10 thru 3/9/10

PV Types: 250 – DME/Medical Supply Dealers

Message:

The Oklahoma Health Care Authority will be hosting a meeting with the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Advisory Committee (DAC) on March 9, 2010 to discuss related issues to DMEPOS for TXIX products and policy.  The agenda for the meeting is now available at the DME webpage of the OHCA website.  A list of the members of the committee and their contact information is provided for your reference at the website location as well. See link below.

/content/sok-wcm/en/okhcaproviders.aspx?id=594&menu=74&parts=7669

The meeting will be held at the Oklahoma Health Care Authority, 4545 N Lincoln Blvd # 124, Oklahoma City, OK  73105 - 405-522-7300    

- - - Sign in at 4:30 p.m. - - -  Meeting from 5:00 p.m. to 7:00 p.m.

New MHSAS member eligibility status in MMIS 

Members may show the new eligibility status of MHSAS in MMIS. This benefit only covers Mental Health and Substance Abuse services for those who meet the medical necessity and other requirements to be seen by an ODMHSAS contracted agency. 

Questions please contact: erin.meyer@okhca.org

Title: SC-10 SoonerCare Choice Referral Form

Run Date: 01/11/2010 – 02/26/2010

PV Type: All

The SC-10 SoonerCare Choice Referral Form is used by a provider to refer members to a specialist. This form should not be used as a prescription for services requiring prior authorization or as a substitute for the physician’s signature.

Effective 01/12/2010 the OHCA Medical Authorization staff can not process a PA request if the SC-10 Form is attached in lieu of a prescription or physician’s signature.

Title: Manual Pricing for Unlisted Surgical Procedures

Run Date: 01/07/2010 – 02/22/2010

PV Type:  31 – Physician, 52 – State Funded Physicians

Message:

To expedite the process of manually pricing claims on unlisted surgical procedures, please include the description of the actual procedure beside the procedure code on the 1500 form. Write the unlisted code beside the procedure description on the operative report. 

Title: Closing CPT Codes

Run Date: 01/11/2010 – 02/26/2010

PV Type:  All

Message:

Effective 1/25/2010 the following CPT codes will no longer be open: 86702, 86703 and 87391. If these codes are used, claims must be submitted with appropriate documentation to support the medical necessity.

If you have questions please contact Provider Services at 1-877-823-4529, option #2. 

Title: FYI - Claims Adjustments

Run Date: 01/04/2010 – 02/20/2010

PV Type: 01 – Hospitals

Message:

Processing difficulties experienced on December 22-24, 2009 resulted in UB Claims not to audit accurately.

Therefore, approximately 31,000 UB claims will be reprocessed the evening of January 4, 2010. Adjustments will run the week of January 11-15, 2010 to correct any claims that may not have properly audited. This fix will not affect region 92.

Your patience in awaiting the outcome of this fix is appreciated.