2013 Global Messages

Last Modified on Feb 25, 2021

Date Posted	Title	Message
12/30/2013	REMINDER: New Paper 1500 Claim Forms	Title: REMINDER: New Paper 1500 Claim Forms Run Dates: 12/20/2013 – 03/31/2014 PV Types: All OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.
12/11/2013	TDaP Guidelines for Pregnant Women	Title: TDaP Guidelines for Pregnant Women Run Date: 12/11/2013 -01/26/2014 PV Types: All Recently, the Advisory Committee on Immunization Practices (ACIP) updated the guidelines for TDaP in pregnant women. The revised ACIP guidelines recommend that health care personnel administer a dose of TDaP during each pregnancy, irrespective of the patient’s prior history of receiving TDaP. To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, optimal timing for TDaP administration is between 27 weeks and 36 weeks of gestation, although TDaP may be given at any time during pregnancy. The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice supports these revised recommendations. SoonerCare covers the TDaP vaccine through a member’s medical home or obstetrician’s office. The TDaP vaccine is also covered for SoonerCare members 19 years of age and older through the pharmacy benefit. A member can receive the vaccine at the health department as well.
12/5/2013	Webinar: Electronic Referrals (New Provider Portal)	Title: Webinar: Electronic Referrals (New Provider Portal) Run Dates: 12/05/2013 – 12/13/2013 PV Types: All HPES and OHCA will be conducting an Electronic Referrals (New Provider Portal) webinar on Dec 12th at 2:30pm. This webinar will introduce providers to the new required electronic referral process within the new SoonerCare provider portal. It will cover how Medical Home (MH) providers will initiate specialty referrals and how specialty providers will receive these referrals. Medical Home providers are strongly encouraged to attend this class as this process replaces the paper referral (SC-10) process beginning this winter. (This class will be limited to the first 150 registrants) Classes offered: Thursday, December 12 - 2:30 p.m. – Electronic Referrals (New Provider Portal) - Click To Register Recommended Audience: All SoonerCare Choice MH providers are strongly encouraged to attend as well as specialty providers whose services require a SoonerCare referral.
12/5/2013	Insure Oklahoma CPAP Humidifier (E0562) Change	Effective January 1, 2014, Insure Oklahoma will allow only rental of the E0562 - Humidifier, heated, used with positive airway pressure device. The prior authorization should be processed using the following guideline: Submit PA for 3 months as rental – use LL modifier Submit PA for convert to Purchase – do not use LL modifier (9 x $19.05= $171.45) Submit claim for exact amount - $171.45 CPAP’s and Humidifiers are eligible for convert to purchase at month 4 only – the purchase option does not apply to BIPAP’s. Future prior authorizations will not be approved for purchase – only rental. If you have any questions, contact Stan Ruffner, DME Director at 405.522.7924.
12/2/2013	Changes in Speech Evaluation Codes	Title: Changes in Speech Evaluation Codes Run Date: 12/02/2013 - 01/17/2014 PV Type: Speech/Hearing Therapist (173); Speech Hearing Clinic (182) Effective January 1, 2014, CPT code 92506 (speech – language evaluation) is being replaced by new, more specific codes. Please refer to the CPT manual for the proper codes for utilization. The last date of service for CPT code 92506 claims will be December 31, 2013. Because of these changes, authorizations for CPT code 92506 will end on December 31, 2013. For all speech PA-related questions, please call the OHCA Call Center at 800-522-0114.
11/25/2013	Mandatory Integration of BH Screenings	Title: Mandatory Integration of BH Screenings Run Dates: 11/25/2013 – 01/05/2014 PV Types: All To all Choice providers You were notified of changes to your Choice contract in October. It involves mandatory integration of Behavioral Health Screenings into your medical home processes for member 5 and above. Please let us know if you did not receive this notification by e-mailing Provider Services Admins: ProviderServicesAdmins@okhca.org . We will send you another copy for your files. Also be aware that Physician Assistants and Advance Nurse Practitioners who are Choice providers must have their DEA and OBNDD on file as part of the contracting approval process. Please call the OHCA call center for questions related to contracting at 1-800-522-0114.
11/22/2013	New Paper 1500 Claim Forms	Title: New Paper 1500 Claim Forms Run Dates: 11/21/2013 – 01/06/2014 And: 12/20/2013 – 03/31/2014 PV Types: All OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.
11/15/2013	Webinar: PA Submission (New Provider Portal)	Title: Webinar: PA Submission (New Provider Portal) Run Date: 11/15/2013 – 11/22/2013 PV Types: All On Thursday November 21st HP will present the Prior Authorization Submission (New Provider Portal) class at 2:30 p.m. These webinars will cover the same information as the Spring/Fall workshops for those that were unable to attend. All SoonerCare providers and their staff that submit DME and medical prior authorizations are encouraged to attend.(PT, OT, ST, surgical, etc.).This class will guide providers through the new process of submitting medical and DME prior authorizations on the new SoonerCare provider portal. This will be a step-by-step guide on the submission process only- this will not include any discussion over approval criteria or prior authorization policy. This class is not for behavioral health, pharmacy or dental providers. (This class will be limited to the first 125 registrants) Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar. November 21st - 2:30 p.m. – Prior Authorization Submission-New Provider Portal Click To Register
11/5/2013	WEBINAR – 1500 Professional Claim Submission – New Provider Portal	Title: WEBINAR – 1500 Professional Claim Submission – New Provider Portal Run Dates: 11/04/2013 – 12/19/2013 PV Types: All Due to the overwhelming response and attendance for the 2013 Spring and Fall Workshops that introduced the new provider portal, HP and OHCA will be conducting webinars to assist providers in getting this important training. On Thursday November 7th, HP will present the 1500-Professional Claim Submission for the New Provider Portal at 2:30 p.m. These webinars will be limited to the first 125 registrants. Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar. November 7th, 2:30 p.m. – 1500-Professional Claim Submission-New Provider Portal Click To Register
10/28/2013	Webinar: Access & Eligibility – New Provider Portal	Title: Webinar: Access & Eligibility – New Provider Portal Run Date: 10/28/2013 – 11/01/2013 PV Types: All For all providers Due to the overwhelming response and attendance for the 2013 Spring and Fall Workshops that introduced the new provider portal, HP and OHCA will be conducting webinars to assist providers in getting this important training. On Thursday October 31st HP will present the Access and Eligibility class at 2:30 p.m. These webinars will be limited to the first 100 registrants. Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar. October 31st - 2:30 p.m. – Access and Eligibility-New Provider Portal Click To Register
10/17/2013	Flu Vaccines	Title: Flu Vaccines Run Dates: 10/16/2013 – 12/02/2013 PV Types: All Flu season is here, and as a provider for our SoonerCare members we wanted to remind you of our coverage for this very important preventive service. Children’s coverage: The flu vaccine is supplied by the Health Department through the Vaccine for Children’s program. Therefore SoonerCare Choice Primary Care Providers will be reimbursed for the administration only. All other SoonerCare providers will be reimbursed for the vaccine and the administration. Adult coverage including Soon to be Sooners members: OHCA will reimburse for the vaccine and the administration. If an adult has a valid prescription from a provider they can receive their flu vaccine at a local pharmacy. We pay the cost of the vaccine and the dispensing fee. SoonerCare Choice Reminder: Referral requirements apply for services outside the member’s Choice primary care provider, other than prenatal/obstetrical care. Refer to Dear Provider letter 2013-31 for clarification regarding administration coverage.
10/15/2013	Long Term Care Cost Reports for SFY13	Title: Long Term Care Cost Reports for SFY13 Run Date: 10/14/2013 – 12/01/2013 PV Types: Provider Types 03 Extended Care Facilities Specialties 30 Nursing Facilities 31 ICF/MR (+6 beds) 34 ICF/MR (-6 beds) 35 Skilled Nursing Facility Attention: All Long Term Care Facility Providers. Long Term Care Cost Reports for SFY13 are due by October 31, 2013. According to the approved State Plan, facilities late in filing the long term care cost report may lose the direct care component of their rate which ranges from $14.02 to $29.91 per patient day. Full year Reports are required to be filed on the secure website and partial year reports are required to be filed on the form available on the OKHCA website: www.OKHCA.org
10/14/2013	Registration for OKC Fall Training	Title: Registration for OKC Fall Training Run Date: 10/14/2013 – 10/25/2013 PV Type: All Registration for the Oklahoma City Workshop on October 23rd and 24th will close today at 5 pm. If you are registered for this workshop, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site. Most classes in OKC are full, therefore walk-ins will be extremely limited and not guaranteed. If you were unable to register for this workshop, please watch your global messages for additional training opportunities.
10/10/2013	Home: Infusion Therapy-Antibiotic, Antiviral, & Antifungal update	Title: Home: Infusion Therapy-Antibiotic, Antiviral, & Antifungal update Run Date: 10/10/2013 – 11/05/2013 PV Types: 250 – DME/Medical Supply Dealers The Oklahoma Health Care Authority is updating the global of 6/17/13 regarding the authorization process for home infusion therapy for Antibiotic, Antiviral and Antifungal for Dual Eligible members only. Please note #5 is now required effective 10/15/2013. All PA requests received as of this date that do not include a CMN (HCA-29) will be cancelled. S9494 – Home infusion therapy, antibiotic, antiviral or antifungal therapy; administration services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately, per diem). Medicare Part D: Effective July 1, 2013, providers serving members with Dual Eligibility benefits (Medicare Part D) will be required to submit the following for a Prior Authorization using the S9494 code: 1. HCA-13A Prior Authorization Fax Cover Sheet 2. HCA12-A Prior Authorization Form 3. Prescription detailing the orders, including duration of treatment 4. Medicare D Billing Response showing payment for the drug 5. HCA-29 OHCA Certificate of Medical Necessity External Infusion Pump is required per OHCA Policy (update 10/4/2013) (*Medical records are NOT REQUIRED to be submitted for Medicare Part D) OHCA will no longer cover the monthly pump rental (E0781 or E0791) for these medications nor the supplies (A4221 or A4222) starting July 1, 2013. Medicare Part B: please continue to file with Medicare. Title XIX: Continue to follow the current process for Prior Authorizations. For all DME/Medical Prior Authorizations related questions, please contact the Medical Authorization Unit at 1-800-522-0114.
10/4/2013	DMEPOS Provider Contract Renewal Period Open Now	Title: DMEPOS Provider Contract Renewal Period Open Now Run Date: 10/04/2013 – 11/19/2013 PV Type: 250 – DME/Medical Supply Dealers DMEPOS CONTRACTS ARE EXPIRING JANUARY 31, 2014. THE ELECTRONIC PROVIDER ENROLLMENT APPLICATION WILL BE AVAILABLE ON THE SECURE WEBSITE AS EARLY AS 10/7/13. REMINDER – WHEN SUBMITTING YOUR RENEWAL CONTRACTS, YOU MUST FAX A COPY OF YOUR PROOF OF ACCREDITATION, YOUR MEDICARE EXEMPTION LETTER; OR A LETTER ADDRESSED TO OHCA REQUESTING AN EXEMPTION FROM THE ACCREDITATION REQUIREMENT. SEE THE EXEMPTION LIST THAT IS POSTED ON THE PUBLIC WEBSITE AT WWW.OKHCA.ORG. BEGINNING WITH THIS RENEWAL PERIOD, OHCA POLICY REQUIRES THAT DMEPOS PROVIDERS MUST HAVE A PHYSICAL LOCATION IN THE STATE OF OKLAHOMA OR REQUEST AN EXCEPTION TO THIS REQUIREMENT. PROVIDER CONTRACTS FOR OUT OF STATE DMEPOS PROVIDERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS. THE OHCA HAS DISCRETION AND THE FINAL AUTHORITY TO APPROVE OR DENY ANY PROVIDER CONTRACT. PLEASE USE THE EMAIL FIELD TO UPDATE YOUR PROVIDER FILE WITH THE EMAIL ADDRESS OF YOUR COMPANIES’ CONTRACT MANAGER YOU MAY CONTACT STAN RUFFNER AT stan.ruffner@okhca.org if you have specific question about exemptions. Otherwise, please contact Provider Enrollment at 800.522.0114 Option 5.
9/30/2013	Tulsa & OKC 2013 Fall Training Workshops	Title: Tulsa & OKC 2013 Fall Training Workshops Run Dates: 09/30/2013 – 10/28/2013 PV Types: All Registration for the Tulsa Workshop on October 9th and 10th will close October 2nd at 5:00 pm. The registration for OKC is still open; however, most classes are full. If you are registered for the Tulsa or OKC workshop, please make every effort to attend. These important trainings are relative to all providers who are currently using the SoonerCare Secure Site. To register, go to: www.okhca.org/register For a list of classes and their descriptions, go to: www.okhca.org/classes
9/24/2013	DSM-V Changes	Title: DSM-V Changes Run Date: 09/24/2013 – 11/09/2013 PV Types: 11, 53 SPC: 110,111, 112,121,115,535,536,585,586 Dear Behavioral Health Provider: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released by the American Psychiatric Association (APA) in May 2013. In order to comply with the APA’s request for insurers to implement the new changes by the end of the year, OHCA and the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) plan to accommodate the DSM-5 by 1/1/2014. The only changes that will impact your daily practice are related to the prior authorization process and fields on the CDC. PICIS will still require diagnoses, but there will be five open diagnoses fields instead of splitting between axis 1 and 2. Axis 4 questions will no longer be required, and will not be visible in PICIS. At provider requests, we will leave the Axis 3 diagnosis field to allow providers to still record medical issues with the customer. DSM-5 was created to cross- walk with both ICD-9 and ICD-10, so there should be no implementation issues when ICD-10 is implemented in late 2014. For inpatient behavioral health providers, the only impact to you will be related to the inpatient clinical templates that are submitted by your utilization review department. New revised templates will be posted on OHCA’s website by December 01, 2013 for use beginning January 01, 2014. If you have any questions, please contact Provider Services at (877)823-4529 option 1.
9/17/2013	Registration for Lawton SC Provider Workshop	Title: Registration for Lawton SC Provider Workshop Run Date: 09/17/2013 – 10/25/2013 PV Type: All Registration for the Lawton SoonerCare Provider Workshop on September 26th will close Thursday Sept 19th at 5 pm. Classes are filling up quickly, therefore walk-ins will be limited in Lawton and on a first come, first serve basis. (Walk-in registrations are not guaranteed.) The registrations for Tulsa(Oct 9 & 10), and OKC (Oct 23 & 24) are still open; however, many classes are full. If you are registered, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site. To register, go to: www.okhca.org/register For a list of classes and their descriptions, go to: www.okhca.org/classes
9/17/2013	Webinar	On September 24, 2013, the HP EDI department will be presenting a webinar over the NPI Crosswalk for Oklahoma SoonerCare Electronic Claims. The Webinar was created to provide information on the SoonerCare solution to the NPI crosswalk and to assist providers in resolving their NPI crosswalk claim denials. We will discuss how to crosswalk an NPI number to the appropriate Medicaid billing or rendering legacy provider id number utilizing additional information, such as zip+4, contract code and taxonomy code. The NPI Crosswalk for Medicare Crossover claims will not be discussed in this presentation. (Class is limited to the first 100 registrants) Target Audience: SoonerCare Providers, billing agents, clearinghouses and software vendors who are currently uploading claims electronically (NOT submitting claims directly on the SoonerCare secure website) and have a desire to learn more about Oklahoma Medicaid NPI Crosswalk are encouraged to attend this webinar. September 24, 2013 - 2:30 p.m. – NPI Crosswalk for Electronic Billers Click To Register
9/12/2013	2013 Durant Fall Training	Title: 2013 Durant Fall Training Run Date: 09/12/2013 – 10/31/2013 PV Types: All Registration for the Durant SoonerCare Provider Workshop on September 16th will close today at 5:00 pm. Classes are filling up quickly, therefore walk-ins will be limited in Durant and on a first come, first serve basis. (Walk-in registrations are not guaranteed.) The registrations for Lawton, OKC, and Tulsa are still open; however, many classes are full. If you are registered, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site. To register, go to: www.okhca.org/register For a list of classes and their descriptions, go to: www.okhca.org/classes
9/10/2013	Fall 2013 School-Based Training	Title: Fall 2013 School-Based Training Run Dates: 09/09/2013 – 10/23/2013 PV Types: 12 SPC: 120 School-Based Training is scheduled for the following dates and times. September 24, 2013 – Oklahoma City (10:00 am to 12:00pm) October 1, 2013 – McAlester (10:00am to 12:00pm) October 08, 2013– Stillwater (10:00am to 12:00pm) October 22, 2013– Poteau (1:00pm to 3:00pm) Register for the training through OHCA website at /content/sok-wcm/en/ohca/schoolbased
9/9/2013	BOTOX Prior Authorization	Title: BOTOX Prior Authorization Run Date: 09/09/2013 – 10/23/2013 PV Types: All As stated in the dear provider letter number 2013-12, Botox requires Prior Authorization through the Pharmacy Prior Authorization Unit. Please use PHARM-24 form to submit your request for Botox.
9/6/2013	Clarification of Recent PA Web Alert	Title: Clarification of Recent PA Web Alert Run Date: 09/04/2013 – 10/19/2013 PV Types: 27 – Dentist Spc: 086 – Dental Clinic Dear Dental Providers: Please be advised that the September 3rd, 2013 web alert regarding Prior Authorizations refers to MEDICAL Prior Authorizations only, not DENTAL. Thank you.
8/13/2013	Heparin Lock Flush	Title: Heparin Lock Flush Run Date: 08/08/2013 – 09/23/2013 PV Types: All Effective 7/1/13, OHCA will no longer allow reimbursement for J1642, heparin lock flush. CMS considers this service integral to the procedures billed when a member has a port for IV access. Heparin flush is not separately billable.
8/8/2013	Coverage of Carrier Screening	Title: Coverage of Carrier Screening Run Dates: 08/09/2013 – 09/15/2013 PV Types: All This message is regarding genetic tests used to determine carrier status for cystic fibrosis (CF), Fragile X, and spinal muscular atrophy (SMA). Consistent with the recommendations set forth by ACMG and ACOG, OHCA considers CF carrier screening using the common mutation panel (CPT code 81220) to be medically necessary once in a lifetime for women of reproductive age and the partners of those that test positive. Expanded mutation panels beyond those recommended by ACMG/ACOG are not considered medically necessary and will be reimbursed at a rate that is based on the common variant panel alone. OHCA does not consider other carrier screening in the general population to be medically necessary. In particular, carrier screening for Fragile X (CPT code 81243) and SMA (CPT code 81401) are not considered medically necessary in the absence of a family history suggestive of those conditions. This is consistent with the ACOG and ACMG recommendations for Fragile X carrier screening and the ACOG recommendations for SMA carrier screening. Please feel free to contact Alison Martinez, Ph.D. at alison.martinez@okhca.org with any questions.
8/8/2013	Nutritional Products Pricing “BY REPORT”	Title: Nutritional Products Pricing “BY REPORT” Run Dates: 08/08/2013 – 11/30/2013 PV Types: 250 – DME/Medical Supply Dealers Effective for prior authorizations submitted after October 1, 2013 for selected enteral nutritional products; providers may use the prices listed on the worksheet posted on the DME website located at www.okhca.org. The worksheet is located under the PRICING tab. For prior authorizations submitted after October 1, 2013; invoices will not be required when the product is listed on this report. The PA will be priced using this report. If the product in question is not on this list, providers must submit an invoice showing cost with the PA request. The report will be updated quarterly – if you have an addition or correction, send to stan.ruffner@okhca.org with the product description, NDC, Manufacturer Product Code and changes will be made if deemed appropriate.
8/5/2013	Webinar re: Speech Therapy Prior Authorization Requests	Title: Webinar re: Speech Therapy Prior Authorization Requests Run Dates: 08/01/2013 – 08/23/2013 PV Types: All The OHCA Medical Authorization Unit will be presenting a webinar for Speech Therapy Prior Authorization Requests. This webinar will review the Prior Authorization process for Speech Therapy, including required documentation and clarification of the 90-day timeframe. The recommended audience would be any SoonerCare provider, including Speech Therapy Providers, needing an overview of the PA submission process for Speech Therapy. This webinar will be limited to the first 100 registrants. We look forward to seeing you. August 22, 2013 @ 2:30 p.m. – OHCA Speech Therapy Prior Authorizations.
7/29/2013	Orthotics Utilization Changes	Title: Orthotics Utilization Changes Run Dates: 07/29/2013 – 12/31/2013 PV Types: 250 – DME/Medical Supply Dealers Due to efforts to insure medical necessity is documented for use of Orthotic devices, OHCA has place reasonable limits on the Orthotic HCPCS codes (L0100-L4999) effective July 1, 2013. You can access the utilization limits on the public website at www. Okhca.org under the Provider Type – DME tab. Policy 317:30-5-211.13 Prosthetic & Orthotic devices indicates that …There is no coverage of orthotics for adults. All items in this classification are eligible for a PA override if the utilization limit has been reached in the past 12 months – an HCA 12A indicating the medical necessity for the additional product along with any growth measurements that will support the need is necessary for the MAU staff to review for appropriateness. This change will allow for medically necessary Orthotic products to be replaced prior to the one year limit if prior authorized. Contact Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org if you have any questions about this change.
7/25/2013	Outpatient Behavioral Health Svs Fee Schedules	Title: Outpatient Behavioral Health Svs Fee Schedules Run Date: 07/24/2013 – 09/08/2013 PV Types: 53 – Licensed Behavioral Health Practitioner (LBHP) Spc: 112 – Psychologist 535 - LBHP Dear Behavioral Health Provider: Effective July 1, 2013 outpatient behavioral health services fee schedules for private Psychologists and Licensed Behavioral Health Professionals (LBHPs) were revised to reflect annual updates to the Medicare fee schedule. The current fee schedules can be located by visiting www.okhca.org/behavioral-health. These rates are effective for claims with dates of service on and after July 1, 2013.
7/23/2013	Audiology Students	Title: Audiology Students Run Date: 07/23/2013 – 09/05/2013 PV Type: 20 Audiologist SPC 200 Audiologist The purpose of this announcement is to give additional guidance on services provided by audiology students. Per OAC 317:30-5-675 SoonerCare eligible speech and hearing providers must be either state licensed speech/language pathologist or state licensed audiologist. Audiology students are not qualified SoonerCare providers, therefore services rendered by a student will not be reimbursed. However, an audiology student may participate in the rendering of the service as long as the qualified, licensed audiologist is: • Present and in the same room, one-to-one with the student for the entire audiology session; and • Guiding the delivery of services; and • Making the skilled judgment; and • Is not engaged in treating another patient or performing another task at the same time. The qualified practitioner is responsible for all services and all documentation. Students may assist in the completion of the documentation and sign the documentation. However, the qualified practitioner must co-sign the documentation, which includes a signed personal attestation. In this attestation, the practitioner must attest to his/her presence and participation during the services, and the completion and accuracy of the audiology assessment, treatment plan, and services rendered.
7/23/2013	New Fee Schedule	Title: New Fee Schedule Run Date: 07/23/2013 - 09/05/2013 PV TYPES: All Remember that we update our fee schedule every July. The new fee schedule is on the web. Dates of service prior to July 1, 2013 are paid at last year’s rate and dates of service after July 1, 2013 are paid at the new rate.
7/23/2013	Medicare Non-Covered Transportation Svs	Title: Medicare Non-Covered Transportation Svs Run Date: 07/23/2013 – 08/31/2013 PV Types: 26 – Transportation 073 – Non ER 260 – Ambulance 261 – Air Ambulance 262 – Bus 263 – Taxi When transportation services are not covered by Medicare and the destination is to the ER, an appeal from Medicare is no longer required. Send the completed HCA-17 form, along with the claim form and the Medicare EOB showing the denial reason to: Attn: Provider Services Oklahoma Health Care Authority PO Box 18506, Oklahoma City, OK 73154.
07/22/2013	SC-10 – SoonerCare Referral Form Clarification for DMEPOS Items	Title: SC-10 – SoonerCare Referral Form Clarification for DMEPOS Items Run Date: 07/17/2013 – 08/05/2013 PV Types: 25 – DME Providers Dear DME Provider: This message clarifies that the use of the SC-10 SoonerCare Referral Form is NOT required for claims for DMEPOS Items. This applies to all DMEPOS claims. Please contact Stan Ruffner, DME Director at stan.ruffner@okhca.org with any questions.
07/15/2013	ACA Primary Care Enhanced Rate Adjustment	Title:ACA Primary Care Enhanced Rate Adjustment PV Type: 09 – Advance Practice Nurse 31 – Physician 10 – Mid-level Practitioner 52 – State Employed Physicians SPC:564 – Eligible Primary Care Provider 093 – Advanced Registered Nurse Pract The first quarter Jan–Mar claims for ACA qualified primary care providers as well as all the vaccine administration claims for kids will be paid on your 7/24 remits. The second quarter Apr–Jun claims for ACA qualified primary care providers will be paid on your 7/31 remits. The EOB code for the enhanced payment is 8147 and the EOB code for vaccine administration is 8155.
7/12/2013	Sign-Up for Web Alerts	Title: Sign-Up for Web Alerts Run Dates: 07/11/2013 – 08/25/2013 PV Types: All To make sure you get updates related to the SoonerCare program please sign up for web alerts on our public website. Especially important is the Provider Letter page. Anyone can sign up for web alerts so multiple members of your staff can receive the updated information. In addition to that method of communication, all of our provider letters are sent electronically. Please log onto the secure site and update your e-mail on your contract file. This will provide another way to have up to date information about SoonerCare. www.okhca.org/webalerts
7/2/2013	School-Based Billing Rates	Title: School-Based Billing Rates Run Date: 07/02/2013 – 08/31/2013 PV Types: 12 / 120 – School-Based Providers Effective 7/1/2013 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
6/25/2013	DEN-3, Dental Provider Change Form	Title: DEN-3, Dental Provider Change Form Run Date: 06/25/2013 – 08/14/2013 PV Types: 27 – Dentist Spc: 086 – Dental Clinic Dental providers: Effective immediately, OHCA has implemented a revised “DEN-3, Dental Provider Change Form”. The form is located on the public website in the “Forms” section. Please replace any old forms you may have on hand. Please note a parent/guardian signature & contact phone is now required for all change of provider requests/transfers. The new rendering dentist will also need to sign the form. This must be completed and faxed to OHCA prior to services rendered. Thank you for your continued support to SoonerCare members, and your cooperation in this matter.
6/17/2013	Home Infusion Therapy – Antibiotic, Antiviral and Antifungal	Title: Home Infusion Therapy – Antibiotic, Antiviral and Antifungal Run Date: 6/17/2013 – 7/31/2013 PV Types: DME/Medical Supply Dealers 250 The Oklahoma Health Care Authority has revised the authorization process for home infusion therapy for Antibiotic, Antiviral and Antifungal for Dual Eligible members only. S9494 – Home infusion therapy, antibiotic, antiviral or antifungal therapy; administration services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately, per diem). Medicare Part D: Effective July 1, 2013, members with Dual Eligibility benefits (Medicare Part D) will be required to submit the following for a Prior Authorization using the S9494 code: 1. HCA-13A Prior Authorization Fax Cover Sheet 2. HCA12-A Prior Authorization Form 3. Prescription detailing the orders, including duration of treatment 4 Medicare D Billing Response showing payment for the drug (***Medical records are NOT REQUIRED to be submitted for Medicare Part D) OHCA will no longer cover the monthly pump rental (E0781 or E0791) for these medications nor the supplies (A4221 or A4222) starting July 1, 2013. Medicare Part B: please continue to file with Medicare. Title XIX: Continue to follow the current process for Prior Authorizations. For all DME/Medical Prior Authorizations related questions, please contact the Medical Authorization Unit at 1-800-522-0114.
6/11/2013	Additional Guidance	Title: Additional Guidance Re: Provider Letter OHCA 2013-05 Run Date: 06/12/2013 – 07/27/2013 PV Types: 173 – Speech/Hearing Therapist 182 – Speech/Hearing Clinic The purpose of this announcement is to give additional guidance on provider letter OHCA 2013-05, dated February 14, 2013 and OHCA policy regarding the prior authorization (PA) process for Speech and Language Pathology services. OHCA policy OAC 317-30-5-676 states “All therapy services, including the initial evaluation, must be prior authorized. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. The prescribing or referring provider must be able to provide, if requested, clinical documentation from the member's medical record that supports the medical necessity for the evaluation and referral.” Other licensed practitioner of the healing arts refers to PAs, ARNPs or CNSs. The intent of this policy language is to assure that all referrals or orders for therapy services are written and signed by the member's treating provider (i.e. Physician, PA, ARNP or CNS). We are informing SLP providers that the referring or ordering provider, whether a physician, PA, ARNP or CNS, must be actively treating the member for which the services are being requested. To insure the referral or order is generated from a provider actively treating the member and that the services are medically necessary, effective immediately any new PA request submitted to the OHCA Medical Authorization Unit will only be considered if submitted with clinical documentation from the member’s treating provider, which supports the medical necessity for the services requested. Any PA request submitted prior to this date will not require this treating provider documentation in order to be considered, however OHCA may still ask for it if necessary to support medical necessity. Additionally, referrals or orders will be considered valid for a maximum of 90 days, i.e. the PA request must be submitted with a signed referral or order no older than 90 days. If you have additional questions please contact the Medical Authorization Unit at 1-800-522-0114.