| Date | Drop Zone | Details |
|---|---|---|
| 12/15/2016 | Coding and Reporting Changes to the SoonerCare Choice Behavioral Health Screening | Title: Coding and Reporting Changes to the SoonerCare Choice Behavioral Health Screening Providers: All Run Dates: 12/15/2016 – 02/01/2017 Effective January 1, 2017, Current Procedural Terminology (CPT) 96160 (Administration and interpretation of patient-focused health risk assessment) will replace 99420 (Administration and interpretation of health risk assessment). This change is necessary due to the new American Medical Association (AMA) codes and guideline revisions being implemented for 2017. For full details regarding this change, please refer to Provider Letter OHCA 2016-31 which can be found at www.okhca.org/providerletters. If you have any questions, please call the OHCA call center at 1-800-522-0114. |
| 12/7/2016 | New Electronic Submission Requirements for Medicare Crossover Claims | Title: New Electronic Submission Requirements for Medicare Crossover Claims Run Date: 12/05/2016 – 01/20/2017 Provider Type: All Effective February 1, 2017, the Oklahoma Health Care Authority (OHCA) will require all Medicare crossover claims to be submitted electronically and in accordance with 42 CFR 424.32. If you are experiencing any issues with your claims crossing over to OHCA electronically, verify that your provider numbers and any Medicare numbers are correct on our files to ensure your claims will process correctly. If you need assistance with submitting your Medicare crossover claims electronically, please call the SoonerCare Helpline at (800) 522-0114. Thank you. |
| 10/19/2016 | SoonerHealth+ Update | TITLE: SoonerHealth+ Update RUN DATE: 10/19/2016 – 12/02/2016 Pv Type: All The Oklahoma Health Care Authority (OHCA) is exploring ways to improve health care services for SoonerCare’s Aged, Blind and Disabled (ABD) populations. During the 2015 legislative session, House Bill 1566 was passed which directed the OHCA to develop a request for proposal (RFP) for a care coordination model for this population. The agency selected a fully capitated, state-wide model of care coordination and named the initiative SoonerHealth+. Although OHCA has not yet released the RFP or awarded any contracts, some health care companies may already be contacting you to determine if you would be interested in contracting with them. You are in no way obligated to do so. However, if the RFP is awarded, the selected health care companies must have a provider network in place in order to serve ABD enrolled members. The OHCA is currently developing the RFP and expects it to be released in November. Based on our current timeline, if the RFP is awarded, beginning in spring of 2018, SoonerCare ABD members that you serve will be enrolled in a managed care organization (MCO), which will be responsible for their health care needs. At that time, to continue to serve those ABD members, you would need to be contracted with the MCO selected. However, until the RFP is awarded, the OHCA is not working with or endorsing any health care company seeking to be the chosen MCO. More information on SoonerHealth+ is available on our website. OHCA will provide additional details on SoonerHealth+ as they become available. |
| 10/19/2016 | Long Term Care Cost Reports SFY16 | TITLE: Long Term Care Cost Reports SFY16 Run Date: 10/19/2016 – 11/05/2016 PV Type: 03/30, 31, 32, 33, 34, 35 Long Term Care Provider Cost Reports for SFY16 are due by 10/31/16. If the cost reports are not received in a timely manner, the facilities may be subject to a rate reduction equal to the amount of the direct care portion of the daily rate ranging $14.90 to $30.68 per patient day. |
| 10/19/2016 | Additional Training Opportunities:Prior Authorization Required Process Change | TITLE: Additional Training Opportunities:Prior Authorization Required Process Change PV TYPES: ALL Run Dates: 10/19/2016 – 11/15/2016 Effective November 1, 2016, the Medical Authorization Unit (MAU) of the Oklahoma Health Care Authority (OHCA) will require prior authorization (PA) requests to be initiated electronically through the SoonerCare Provider Portal. For full details regarding this change, please refer to Provider Letter OHCA 2016-29 which can be found at: www.okhca.org/providerletters. Due to the high demand of our previous webinar on this topic, the Oklahoma Health Care Authority (OHCA) is offering additional training to help providers understand and meet these requirements. Webinars are scheduled for October 26, 2016, at 2 p.m. and November 10, 2016, at 2 p.m. OHCA recommends this presentation for all providers who submit or will begin submitting PA’s through the SoonerCare Provider Portal after November 1, 2016. This change does not include dental, pharmacy or behavioral health PAs. We will also address your questions at that time. Please register at http://okhca.org/provider-training. Thank you. |
| 10/5/2016 | Training Opportunity: Prior Authorization Required | TITLE: Training Opportunity: Prior Authorization Required Process Change PV TYPES: ALL Run Dates: 10/05/2016 – 11/01/2016 Effective November 1, 2016, the Medical Authorization Unit (MAU) of the Oklahoma Health Care Authority (OHCA) will require prior authorization (PA) requests to be initiated electronically through the SoonerCare Provider Portal. For full details regarding this change, please refer to Provider Letter OHCA 2016-29 which can be found at: www.okhca.org/providerletters. We are offering a webinar that will focus on helping providers understand and prepare for this change. The webinar will be on October 18, 2016, at 2 p.m. OHCA recommends this presentation for all providers who submit or will begin submitting PA’s through the SoonerCare Provider Portal after November 1, 2016. This change does not include dental, pharmacy or behavioral health PAs. We will also address your questions at that time. Please register at http://okhca.org/provider-training. Thank you. |
| 9/29/2016 | Effective November 1, 2016: Prior Authorization Required Process Change | TITLE: Effective November 1, 2016: Prior Authorization Required Process Change Run Dates: 09/30/2016 – 11/15/2016 PV TYPES: ALL This global is to inform providers that effective November 1, 2016 the Oklahoma Health Care Authority (OHCA) Medical Authorization Unit (MAU) will require prior authorization (PA) requests to be initiated electronically through the SoonerCare Provider Portal. After initiation of the PA request, providers may submit the necessary clinical records, photos and supporting documentation electronically. The OHCA prefers all documentation to be uploaded electronically, but will continue to accept documentation by fax or mail through June 30, 2017. However, by July 1, 2017, OHCA intends to transition to an electronic PA submission process inclusive of documentation consistent with OHCA’s commitment to going “green” and reducing costs. OHCA will provide additional information as this process progresses. This November 1, 2016 transition for PA requests to be initiated electronically through the SoonerCare Provider Portal will now include the following five areas: Spine Procedures, Joint Procedures, Cardiology Procedures, Pain Management and Radiation Therapy. Please note that this November 1, 2016, transition does not include dental, pharmacy or behavioral health PAs. A provider letter outlining this change and providing additional information will be sent soon and will also be found at: www.okhca.org/providerletters. Please consider signing up for “WebAlerts” on this page to be notified when this and other new Provider Letters are posted. We will also be offering provider training to help prepare for this change. A global message with more detailed information about the training will also be posted soon. If you need assistance with reviewing your prior authorizations online or submitting your clinical documentation or prior authorizations electronically, please call the SoonerCare Helpline at (800) 522-0114. Thank you for your continued support of our SoonerCare program. |
| 9/29/2016 | C-Section Rates Letters | TITLE: C-Section Rates Letters Run Dates: 09/29/2016 – 11/11/2016 PV Types: 01; 08; 31; 52 The year-end C-section rates are now available electronically, through the OHCA Provider Portal letters. If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Internet Helpdesk; choose option 1 for your questions concerning the Provider Portal. You may also view the release schedule on the OHCA webpage at www.okhca.org/c-section. Thank you. |
| 9/13/2016 | Training Opportunity: Urine Drug Testing and Prior Authorization Requirements | TITLE: Training Opportunity: Urine Drug Testing and Prior Authorization Requirements RUN DATES: 09/13/2016 – 09/28/2016 PV TYPES: All The Oklahoma Health Care Authority (OHCA) revised urine drug screening and testing policy OAC 317:30-5-20.1 to update terminology of “presumptive” and “definitive” drug testing to mirror CPT/HCPCS coding reference manuals. Prior authorization (PA) for definitive drug testing went into effect March 1, 2016. Providers have verbalized confusion on the documentation required for the PA process. This webinar is to help providers understand the differences between presumptive and definitive drug testing and what documentation is required for the PA process. We will also show providers where the requirements and forms are located on the OHCA website. This webinar will be on September 27 at 2 p.m. OHCA recommends this presentation for all providers who provide, order and bill for urine drug testing services. We will also address your questions at that time. Please register at http://okhca.org/provider-training. Thank you. |
| 9/7/2016 | Last Day of Prior Authorizations Change (Psychiatric Residential Treatment Facilities) Training Opportunity | Title: Last Day of Prior Authorizations Change (Psychiatric Residential Treatment Facilities) Training Opportunity Run Dates: 9/7/16-10/21/2016 PV: 01 013 015 Effective October 3, 2016, the Behavioral Health Unit of the Oklahoma Health Care Authority will implement a change regarding the last day of prior authorizations for Psychiatric Residential Treatment Facilities. Presently, the last day of a prior authorization includes a billable unit for that day; however, beginning October 3, 2016, the last day will no longer be billable. This change will assist providers with correctly submitting claims that reflect when the member was discharged from care. We are offering a webinar to help providers understand and prepare for this change. The webinar will be on September 15 at 2 p.m. OHCA recommends this presentation for EDI vendors, billers and utilization review personnel. Time will be given to address your questions. Please register by going to http://okhca.org/provider-training. |
| 9/1/2016 | Suspending Coverage of Live Attenuated Influenza Vaccine | Title: Suspending Coverage of Live Attenuated Influenza VaccineRun Dates: 9/1/16-11/14/2016 PV: ALL The Oklahoma Health Care Authority allows immunizations as per the CDC’s Advisory Committee on Immunization Practices (ACIP) guidelines. Recently the Committee recommended the live attenuated influenza vaccine (LAIV), also known as “nasal spray” flu vaccine, should not be utilized for the 2016-2017 flu season. CPT 90672, the code utilized for the LAIV nasal vaccine, also known as “FluMist”, will be suspended effective September 1, 2016. |
| 8/31/2016 | Billing Changes for Behavioral Health Assessments in Outpatient Agencies (HCPCS H0031) | Title: Billing Changes for Behavioral Health Assessments in Outpatient Agencies (HCPCS H0031) Run Dates: 8/31/2016 through 9/30/2016 PV: PV 11 SoonerCare rules were revised during 2016 permanent rulemaking to remove specific minimum time requirements for behavioral health assessment services provided in outpatient behavioral health agencies. Previous rules required at least 1.5 hours in order to bill a low complexity assessment and over 2 hours to bill a moderate complexity assessment. Current reimbursement rates vary based on the complexity of the assessment as well as whether the assessment was performed for an adult or child member. To correspond with the rule changes, new event-based reimbursement rates for assessments were created which are the same regardless of time spent on the assessment or the age of the client. Beginning September 1, 2016, the rate for assessments provided by fully licensed LBHPs will be $103.33. The rate for licensure candidates will be $90.41. The TF modifier (indicating low complexity) will no longer be reimbursable for H0031. |
| 8/30/2016 | Dear Provider Letter 2016-26 | Title: Dear Provider Letter 2016-26 Run Dates: 8/31/2016-10/14/2016 PV Types: 01, 08, 09, 10, 11, 28, 31, 52 Provider Letter 2016-26 serves to inform providers on the prior authorization process for definitive urine drug testing. Please post all comments by close of business, Friday, September 30, 2016 via the policy change blog. Thank you for your participation in this process. |
| 8/25/2016 | Unbundling of Obstetrical (OB) Services Delayed | Title: Unbundling of Obstetrical (OB) Services Delayed Run Dates: 8/26/16-10/10/16 PV TYPES: ALL OHCA will be delaying the OB unbundling changes reflected in provider letter 2016-20 that were going to become effective September 1, 2016. If you have any questions, please call the OHCA call center at 1-800-522-0114. |
| 8/24/2016 | Dear Provider Letter 2016-24 | New Global Message: Title: Dear Provider Letter 2016-24 Run Dates: 8/19/2016-10/3/2016 PV Types: 05 Provider Letter 2016-24 serves to inform providers about face to face requirements for Home Health Services, effective immediately. Please post all comments by close of business, Thursday, September 22, 2016 via the policy change blog. Thank you for your participation in this process. |
| 8/22/2016 | Autonomic Function Testing Reimbursement Changes | Title: Autonomic Function Testing Reimbursement Changes Run Date: 08/18/2016 – 10/01/2016 PV Types: 08, 09, 10, 31, 52 Effective September 1, 2016, OHCA will no longer reimburse for CPT code 95943. As per CMS guidelines, OHCA considers parasympathetic and sympathetic heart rate testing described by CPT 95943 to be a component of an initial neurologic assessment. This code was not developed and intended to be specific to any brand/manufacturer. If a provider finds that this non-standardized component information of autonomic function testing is useful in a patient assessment and clinical decision making given certain patient risks/signs/symptoms, this would be included in the physician’s basic evaluation and management service and not separately covered. Also effective September 1, 2016, reimbursement for CPT codes 95921 and 95922 will be restricted to the following provider types only: 312-Cardiologist, 326-Neurologist, 523-Child Neurology and 550-Pediatrics Cardiology as per recommended guidelines. 95921 - testing of autonomic nervous system function; cardiovagal innervation (parasympathetic function), including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ration and 30:15 ration. 95922 - testing of autonomic nervous system function; vasomotor adrenergic innervation (sympathetic adrenergic function), including beat-to-beat blood pressure and R-R interval changes during Valsalva maneuver and at least 5 minutes of passive tilt. 95943 - simultaneous, independent, quantitative measures of both parasympathetic function and sympathetic function, based on time-frequency analysis of heart rate variability concurrent with time-frequency analysis of continuous respiratory activity, with mean heart rate and blood pressure measures, during rest, passed (deep) breathing, Valsalva maneuvers, and head-up postural change). |
| 8/17/2016 | Enteral Nutrition Changes to PA Process | Title: Enteral Nutrition Changes to PA Process Run Dates: 08/17/2016 – 12/31/2016 PV Types: 250 – DME/Medical Supply Dealers Effective immediately, all enteral prior authorization (PA) requests to the Oklahoma Health Care Authority (OHCA) may be requested to cover a time period up to a maximum of one year. We have determined that this change will reduce your workload, OHCA staff workload and extend the PA period by an additional six months. To increase, decrease or change enteral formula of an active approved PA, please submit changes as an amendment to the PA for review. If you have questions regarding this process, please email DMEADMIN@okhca.org for a response from the OHCA Durable Medical Equipment (DME) Team. Thank you. |
| 8/16/2016 | Dear Provider Letter 2016-25 | Title: Dear Provider Letter 2016-25 Run Dates: 8/16/2016 -10/01/2016 PV Types: 03, 36, 38, 163 Provider Letter 2016-25 informs providers about ordering, referring, and rendering. It provides additional guidance for Provider Letter 2013-44 and the global notification for CMS Federal Requirement for Ordering and Referring. Please post all comments by close of business, Thursday, September 15, 2016, via the Policy Change Blog. Thank you for your participation in this process. |
| 8/16/2016 | Unbundling Obstetrical Services Training Opportunity | Title: Unbundling Obstetrical Services Training Opportunity Run Dates: 08/16/2016 – 08/26/2016 PV Types: All Obstetrical (OB) services policy at OAC 317:30-5-2 and 317:30-5-22 is revised to amend the reimbursement structure for OB services. Currently the agency utilizes the global care CPT codes for routine OB care billing, which can be used if the provider rendered care for a member for greater than one trimester. The revised policy will require OB care be billed using the appropriate evaluation and management codes for antepartum care, as well as the appropriate delivery-only and postpartum care services when rendered. For full details regarding this revision, please reference Provider Letter 2016-20, which can be found at www.okhca.org/providerletters. We are offering a webinar to help providers understand and prepare for this revision. The webinar will be on August 24, 2016, at 2 p.m. OHCA recommends this presentation for all providers who provide and bill for OB services. We will also address your questions at that time. Please register by going to: http://okhca.org/provider-training. |
| 8/15/2016 | Complex Rehab Technology Provisions | Title: Complex Rehab Technology Provisions Run Dates: 08/12/2016 – 12/31/2016 PV Types: 250 – DME/Medical Supply Dealers State law has been passed to establish focused regulations for products and services classified as CRT (Complex Rehab Technology). Effective September 1, 2016, a CRT code set will be limited to those providers who meet the CRT specific supplier standards. The revisions establish requirements and restrict the provision of CRT to only qualified suppliers. See Provider Letter 2016-10 dated July 29, 2016. The new specialty provider type will be 252 – Complex Rehab Technology Supplier. Requirements include the following: 1) Eligible providers must be Accredited to dispense CRT 2) Eligible providers must be contracted with Medicare 3) Eligible providers must employ a CRT professional as a W-2 employee 4) Eligible provider must comply with RESNA standards If your company meets the qualification and have an interest in applying for the Specialty Code; please contract Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org for additional clarification. |
| 8/1/2016 | New Dear Provider Letters | Title: New Dear Provider Letters Run Dates: 08/01/2016 – 09/15/2016 PV Types: All Provider Letters 2016-09 through 2016-19, as well Provider Letter 2016-23, outline OHCA program and policy updates that will become effective September 1, 2016. For full details about these changes, please visit www.okhca.org/providerletters. |
| 7/29/2016 | Email for PA Inquiries | Title: Email for PA Inquiries Run Dates: 07/29/2016 – 09/15/2016 PV TYPES: 250 – DME/Medical Supply Dealers The Oklahoma Health Care Authority (OHCA) has a new email address for DME suppliers to use for inquiries related to DME prior authorizations (PAs): DMEADMIN@okhca.org. Please use this email address to contact us about your PA questions instead of contacting the OHCA Help Desk. Since the Provider Portal provides notes that explain the review by our DME staff, we expect that suppliers will access those PA notes prior to submitting an email inquiry. (An email is a last resort to resolve the PA inquiry.) The goal is to centralize the inquiries for DME suppliers in our effort to provide clarification on the PA decisions made. We will send responses made by DME staff via secure email to insure HIPAA compliance with protected health information (PHI). Thank you for your consideration. Contact Stan Ruffner, DMEPOS director, at stan.ruffner@okhca.org for additional clarification. |
| 7/29/2016 | Dear Provider Letter 2016-17 | Title: Dear Provider Letter 2016-17 Run Dates: 7/28/16-9/10/16 PV Types: 019, 082, 085, 088, 180, 183, 188, 196, 330, 345, 543 Provider letter 2016-17 outlines OHCA Program and Policy Updates regarding optical supplies that will become effective September 1, 2016. Please post all comments by close of business Monday, August 29, 2016, via the Oklahoma Health Care Authority (OHCA) Policy Change Blog. Thank you for your participation in the process. |
| 7/28/2016 | Ordering & Referring Training Opportunities | Title: Ordering & Referring Training Opportunities Run Date: 07/22/2016 – 09/10/2016 PV Types: All 42 CFR § 455.440, requires that all payment claims for items and services that were ordered/referred contain the National Provider Identifier (NPI) of the physician or other professional who ordered/referred such items or services. Due to the high demand of our previous two webinars on this topic, the Oklahoma Health Care Authority (OHCA) is offering additional training to help providers understand and meet these requirements. Webinars are August 10, 2016, at 2 p.m. and August 18, 2016, at 2 p.m. OHCA recommends these webinars for all SoonerCare providers who order or refer services and those providers who receive orders or referrals. Learn what information is required, how to use the SoonerCare Provider Portal to transmit this information, and the proper way to submit claims that meet this requirement. Time will also be given to address your questions. To register, please visit http://okhca.org/provider-training. For questions, please contact OHCA Provider Services at 1-800-522-0114, option 1. |
| 7/28/2016 | Dear Provider Letter 2016-22 | Title: Dear Provider Letter 2016-22 Run Dates: 7/28/2016 - 9/10/2016 PV TYPES: 451 Provider letter 2016-22 outlines OHCA program and policy updates to therapeutic foster care that will become effective September 1, 2016. Please post all comments by close of business Monday, August 29, 2016, via the Oklahoma Health Care Authority (OHCA) Policy Change Blog. Thank you for your participation in the process. |
| 7/28/2016 | Dear Provider Letter 2016-21 | Title: Dear Provider Letter 2016-21 Run Dates: 7/28/16-9/10/16 PV Types: 01, 02, 08, 09, 10, 13, 16, 28, 31, 52, 57 Provider letter 2016-21 serves to inform providers on the prior authorization of molecular pathology CPT codes related to hereditary cancer susceptibility testing, effective September 1, 2016. Please post all comments by close of business Monday, August 29, 2016, via the the Oklahoma Health Care Authority (OHCA) Policy Change Blog. Thank you for your participation in the process. |
| 7/28/2016 | Critical Incident Reporting | Title: Critical Incident Reporting Run Date: August 1, 2016 to September 15, 2016 PV Type: 01 Spc: 013, 015 As required by OAC 317:30-5-95.39 an Section 42 CFR_483.374(c), psychiatric residential treatment facilities (PRTFs) providing services for members under age 21 must submit critical incident reports to the Oklahoma Health Care Authority (OHCA) as part of their established provider agreement. Critical incidents, as defined by OAC 317:30-5-95.39, includes death, serious injury or suicide attempt. PRTFs must also report SoonerCare member deaths to the Centers for Medicare and Medicaid Services (CMS) regional office in Dallas, Texas. The hospital administrator, executive director or designee is required to contact the OHCA Behavioral Health Unit by phone no later than 5 p.m. on the business day following the incident. The report must include the name of the SoonerCare member involved, the basic facts of the incident, and the facility’s follow-up procedures in regard to the incident. The OHCA Behavioral Health Unit must receive the above information in writing within three (3) business days (Ex: facility critical incident report). Please fax your critical incident reports directly to OHCA at 405-530-7260. For questions, please contact the OHCA Behavioral Health Operations Unit at 405-522-7017. |
| 7/26/2016 | Unbundling Obstetrical Services | TITLE: Unbundling Obstetrical Services Run Date: 07/26/2016 – 09/15/2016 PV Type: All Obstetrical (OB) services policy at OAC 317:30-5-2 and 317:30-5-22 is revised to amend the reimbursement structure for OB services. Currently the agency utilizes the global care CPT codes for routine OB care billing, which can be used if the provider rendered care for a member for greater than one trimester. The revised policy will require OB care be billed using the appropriate evaluation and management codes for antepartum care, as well as the appropriate delivery-only and postpartum care services when rendered. The change allows for more accurate tracking of antepartum and postpartum services. Effective September 1, 2016, all global OB CPT codes will not be eligible for reimbursement. This includes CPT 59400, 59410, 59425, 59426, 59510, 59515, 59610, 59614, 59618 and 59622. There will be two different billing periods for OB care - one for services rendered up to August 31, 2016, and another for services rendered from September 1, 2016, forward. For full details, please reference Provider Letter 2016-20, which can be found at www.okhca.org/providerletters. |
| 7/25/2016 | Ordering Provider on Medicare Crossover Claims | Title: Ordering Provider on Medicare Crossover Claims Run Date: 07/18/2016 – 09/05/2016 PV Type: All Due to a recent system change, our system now captures Medicare Crossover claim detail-level data and pays the claim at the detail level. In the past the Oklahoma Health Care Authority (OHCA) paid the entire claim at the header level, so no ordering provider was required. If the provider does not include the ordering physician on the Medicare claim, then the crossover claim will deny with an error stating that there is no ordering physician listed (edit 1138). For claims that have denied for this reason, providers must void the claim, list the ordering provider, and resubmit. The provider can only void a claim if it is paid status. They can have a paid claim with details that denied for this reason, which is why they would need to void the claim, correct the denial and refile a new claim. If you have questions regarding these changes, please contact OHCA Provider Services at 1-800-522-0114, option 1. |
| 7/15/2016 | TFC Rendering Provider Enrollment | TITLE: TFC Rendering Provider Enrollment Run Date: 07/15/2016 – 08/01/2016 PV Type: 45 Beginning August 1, 2016, therapeutic foster care agencies submitting claims for payment to OHCA are required to include the rendering providers assigned to their Oklahoma Medicaid Group ID on the claim. The rendering service provider is appointed to the stated group (therapeutic foster care agency) for receipt of payment for Medicaid-compensable health care services and directs the OHCA to make all such payments to the group. This is regardless of any other agreement the rendering provider has with the OHCA. OHCA does not make direct payments to the rendering provider. After August 1, 2016, therapeutic foster care agencies that do not submit rendering providers on their claims will receive denials in the claims system for payment. You may fax your Appendix A directly to 405-530-3454. For questions, please call 1-800-522-0114 and select option 5. |
| 7/11/2016 | Electronic signatures accepted for 2016 EHR attestations | Title: Electronic signatures accepted for 2016 EHR attestations Run date: 07/11/2016 – 08/26/2016 PV Types: 31, 52, 09, 27, 10 The OHCA EHR Incentive Team would like to announce that electronic signatures will be accepted starting 7/7/2016. It will no longer be required to submit the SoonerCare Provider Agreement Signature Form with your uploaded documentation. If you have questions or need more information please contact the EHR Incentive Team at 405-522-7347, okehrincentive@okhca.org, or visit our website: www.okhca.org/ehr-incentive. If you have any questions or need more information on the upload process, please contact the EHR Incentive Team at 405-522-7347, okehrincentive@okhca.org or visit our website: www.okhca.org/ehr-incentive. |
| 7/11/2016 | Updates to HIPAA Adjustment Reason Codes | Title: Updates to HIPAA Adjustment Reason Codes Run Dates: 07/11/2016 – 08/23/2016 PV Types: All We wanted to inform you that the Oklahoma Health Care Authority (OHCA) is updating the Explanation of Benefits (EOBs) and the HIPAA Adjustment Reason Codes you receive on your remit and 835. These changes are to provide better information on claim denials. Updates should be complete by the end of July 2016. If you have questions regarding these changes, please contact OHCA Provider Services at 1-800-522-0114, option 1. |
| 7/6/2016 | Ordering & Referring Training Opportunities | Title: Ordering & Referring Training Opportunities Run Dates: 07/06/2016 – 08/01/2016 PV Types: All 42 CFR § 455.440, requires that all claims for payment for items and services that were ordered or referred contain the National Provider Identifier (NPI) of the physician or other professional who ordered or referred such items or services. We are offering two webinars that will focus on helping providers understand and meet these requirements. The webinars will be on July 14 at 2 p.m. and July 21 at 2 p.m. and are recommended for all SoonerCare Choice Patient Centered Medical Homes, providers that order services and providers that receive orders or electronic referrals. Providers will learn about the information that is required, how to use the SoonerCare Provider Portal to transmit this information and how to appropriately submit claims that meet this requirement. Time will also be given to address your questions. Please register by going to: http://okhca.org/provider-training If you have any questions, you may also contact Provider Services at 1-800-522-0114, option 1. |
| 7/6/2016 | Dear Provider Letter 2016-08 | Title: Dear Provider Letter 2016-08 Run Date: 7/6/2016 thru 8/19/2016 PV Types: 080, 081, 083, 084, 091, 181, 184, 185, 199, 328, 335 Provider letter 2016-08 serves to inform providers on the expanding coverage of Makena and vaginal progesterone, effective August 1, 2016. Please post all comments by close of business, Friday, August 5, 2016, via the policy change blog. Thank you for your participation in the process. |
| 6/30/2016 | New Cesarean Section Rates Retrieval Process | Title: New Cesarean Section Rates Retrieval Process Run Date: 06/30/2016 – 08/15/2016 PV Types: 01; 08; 31; 52 As part of our “green” process, quarterly C-section rate letters are now available electronically, through the OHCA Provider Portal. Eliminating printing and postage for these correspondences are the agency’s best ways to reduce some of our administrative costs. You may also view the release schedule on the OHCA webpage at www.okhca.org/c-section. If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Internet Helpdesk; choose option 1 for your questions concerning the Provider Portal. |
| 6/22/2016 | Ordering and Referring System Changes | Title: Ordering and Referring System Changes Run Date: 06/22/2016 – 08/05/2016 Pv Types: All Subject: Ordering and Referring System Changes 42 CFR § 455.440 requires that all claims for payment for items and services that were ordered or referred to contain the National Provider Identifier (NPI) of the physician or other professional who ordered or referred such items or services. In order to comply with this requirement: · The physician or other professional who ordered or referred the item or service must have an active SoonerCare contract. · The ordering or referring NPI on the claim must be for an individual, not for a group. · The ordering or referring provider must be of a specialty type that is eligible to order or refer. In order to comply with the second bullet point, additional system edits went into effect on 6/16/2016. After going into effect, more claims related to the referral edits denied than anticipated. Therefore, in order to allow providers more time to prepare for this requirement, we have temporarily removed the referring NPI edits. For easy reference, the common “referring” edits are: 4250 – Referring provider not contracted as individual 4259 – Referring not recipient’s PCP or not member of PCP group 4290 – Referring provider cannot be group provider Edits for the ordering NPI remain active. Any claims submitted without the individual ordering NPI will continue to deny. Common “ordering” related edits are: 1136 – Ordering provider not eligible on date of service 1138 – Ordering provider is required for HCPCS/CPT code We will be offering provider training focused on understanding and meeting these requirements. A global message with more detailed training information will be posted soon. If you have any questions, please contact Provider Services at 1-800-522-0114, option 1. |
| 6/16/2016 | Revised Caries Risk Assessment Form | Title: Revised Caries Risk Assessment Form Run Date: 06/14/2016 – 08/01/2016 PV Types: 027 Spc: 086, 271, 272, 273, 274, 275, 276, 277, 278 Global Message to all dental providers: OHCA has posted a revised Caries Risk Assessment Form on the OHCA public website Forms page: http://www.okhca.org/forms. More information regarding the Caries Risk Assessment may also be found on the Dental page of OHCA public website: http://www.okhca.org/dental-providers. |
| 6/14/2016 | School Based IEP services change for ORDERING/REFERRING NPI | Title: School Based IEP services change for ORDERING/REFERRING NPI Run Dates: June 20, 2016 – July 31, 2016 PV Type: 12/120 Beginning June 20, 2016, contracted therapy companies submitting claims on behalf of OHCA contracted schools for IEP related services (for place of service 03 with a TM modifier) will no longer use the school’s NPI in the ordering/referring field. As stated in Provider Letter 2013-44, this notice is in reference to 42 CFR 455.440, which states “that the State Medicaid agency requires the NPI of any ordering or referring physician or other professional to be specified on the claims for payment that is based on an order or referral of the physician or other professional”. |
| 6/13/2016 | Physicians Contracts Expire 09/30/2016 | Title: Physicians Contracts Expire 09/30/2016 Run Date: 06/14/2016 – 10/01/2016 PV Types: All Physician contracts expire September 30, 2016, but the renewal process begins July 18. To avoid any delay in reimbursement, we encourage physicians to begin their renewals as soon as possible starting July 18. If you have any questions, please contact Provider Enrollment at 1-800-522-0114, option 5. |
| 6/13/2016 | New Fee Schedule | Title: New Fee Schedule Run Date: 06/08/2016 – 07/31/2016 PV Types: All Remember that we update our fee schedule every July to rebase to the new Medicare RVUs. This update goes into effect on July 1 to match our state fiscal year. The new fee schedule will be on our public website as soon as possible. Dates of service prior to July 1, 2016, are paid at last year’s rate and dates of service after July 1, 2016, are paid at the new rate. |
| 6/13/2016 | Psychiatric Residential Treatment Facilities Attestation | Subject: Psychiatric Residential Treatment Facilities Attestation Run Dates: 06/15/2016 – 08/01/2016 PV Types: 01 Spc: 013, 015 As required by OAC 317:30-5-95, Psychiatric Residential Treatment Facilities must submit an attestation statement to the Oklahoma Health Care Authority as part of their established provider agreement. Attestation statements are to be submitted annually and should be uploaded to the facility’s provider file through the Electronic Provider Enrollment System by the first of each fiscal year, July 1. • Attestations must include the following information: Facility General Characteristics: name, address, telephone number of the facility, and provider identification number; Facility Specific Characteristics: o Bed size; o Number of individuals currently served within the PRTF who are provided service based on their eligibility for the Medicaid Inpatient Psychiatric Services for Individuals Under age 21 Benefit (Psych under 21); o Number of individuals, if any, whose Medicaid Inpatient Psychiatric Services Under 21 Benefit is paid for by any State other than Oklahoma; and o List all States from which the PRTF has ever received Medicaid payment for the provision of Psych under 21 services. The signature of the facility director; The date the attestation was signed; A statement certifying that the facility currently meets all of the requirements of Part 483, Subpart G governing the use of restraint and seclusion; A statement acknowledging the right of the SA (or its agents) and, if necessary, CMS to conduct an onsite survey at any time to validate the facility’s compliance with the requirements of the rule, to investigate complaints lodged against the facility, or to investigate serious occurrences; A statement that the facility will submit a new attestation of compliance annually and in the event a new facility director is appointed. |
| 6/2/2016 | Provider Payments Adjudicated the week of June 27, 2016 | Title: Provider Payments Adjudicated the week of June 27, 2016 Run Dates: June 1, 2016 – July 15, 2016 PV Types: All OHCA will delay payment for the claims adjudicated the week of June 27, 2016. You will not receive a payment on June 29, 2016. The delayed payments will be made along with adjudicated claims incurred the following week on July 6, 2016. Please make arrangements to accommodate this change. |
| 6/1/2016 | Change in limits for Psychotherapy Provided by Independent LBHPs | Title: Change in limits for Psychotherapy Provided by Independent LBHPs Run Dates: 06/01/2016 – 07/15/2016 PV Types: 08, 53 Spc: 193 Pursuant to emergency rules signed by the Governor found at 317:30-5-281, effective June 1, 2016, limits on psychotherapy provided by independent licensed behavioral health professionals (LBHPs) have changed. Psychotherapy is now limited to four (4) units/session per client per month. |
| 6/1/2016 | Change in limits for psychotherapy and service plan updates provided by Outpatient Behavioral Health Agencies | Title: Change in limits for psychotherapy and service plan updates provided by Outpatient Behavioral Health Agencies Run Dates: June 1, 2016 thru July 15, 2016 PV Types: 11 All Specialties Pursuant to emergency rules signed by the Governor found at 317:30-5-241.2, effective June 1, 2016, limits on psychotherapy provided by outpatient behavioral health agencies have changed. Individual Therapy is now limited to four (4) units per day per client; family therapy is limited to 4 units per day per client; and group therapy is limited to six (6) units per day per client. Additionally, group therapy has a weekly limit of no more than three (3) hours per week per client. Individual and family therapy have a cumulative weekly limit of no more than 2 hours combined per week per client. Also effective June 1, 2016, service plan updates will only be reimbursable every six (6) months. |
| 5/13/2016 | Claims Submitted By Behavioral Health Licensure Candidates Are Now Processing Correctly | Claims Submitted By Behavioral Health Licensure Candidates Are Now Processing Correctly Run Dates: May 13, 2016 through June 25, 2016 Provider Type 11 All Specialties The systems error that was denying claims submitted by behavioral health licensure candidates has been fixed. If you have experienced denied claims for Licensure Candidates since 5/1/2016, you can now re-file your claims. We apologize for the inconvenience this issue has caused. |
| 5/11/2016 | Billing Error for Claims Submitted by Behavioral Health Licensure Candidates | Billing Error for Claims Submitted by Behavioral Health Licensure Candidates Run Date: 05/09/2016 – 06/22/2016 Provider Type 11 All Specialties A systems error has been identified that is denying claims submitted on behalf of Behavioral Health Licensure Candidates for dates of service on and after 5/1/2016. We apologize for this inconvenience and are diligently working to address the error. Once the system is fixed, we will send a notice to providers so that denied claims can be resubmitted. |
| 5/3/2016 | Fee Schedule for Outpatient Behavioral Health Agencies | Fee Schedule for Outpatient Behavioral Health Agencies Run Dates: May 2, 2016 through June 15, 2016 PV Types: 11 All Specialties The fee schedule for outpatient behavioral health agencies has been updated and is effective 5/1/2016. The new fee schedule is located at www.okhca.org/behavioral-health. Dates of service prior to 5/1/2016 are paid at previous rates and dates of service after 5/1/2016 will be paid at the new rates. |
| 5/2/2016 | New Fee Schedule for Independently Contracted Licensed Behavioral Professionals (LBHPs) | New Fee Schedule for Independently Contracted Licensed Behavioral Professionals (LBHPs) Run Dates: April 29, 2016 through June 13, 2016 PV Types: 53 (LBHP) All Specialties 08 (clinics) 193 (Behavioral Health Group) The fee schedule for independently contracted Licensed Behavioral Health Professionals (LBHPs) has been updated and will be effective 5/1/2016. The new independent LBHP fee schedule is located at www.okhca.org/behavioral-health |
| 5/2/2016 | New Fee Schedule for Independently Contracted Psychologists | New Fee Schedule for Independently Contracted Psychologists Run Dates: April 29, 2016 through June 13, 2016 PV Type 11 Specialty 112 PV Type 53 Specialty 112 PV Type 08 Specialty 193 The fee schedule for independently contracted Psychologists has been updated and will be effective 5/1/2016. The new independent Psychologist fee schedule is located at www.okhca.org/behavioral-health |
| 4/25/2016 | Provider Letter 2016-05 | Title: Provider Letter 2016-05 PV Types: 27, 80, 84, 86 Provider letter 2016-05 serves to inform providers about newly activated dental codes and the caries risk assessment form. Please post all comments by close of business, Wednesday, May 15, 2016 via the policy change blog. Thank you for your participation in the process. |
| 4/18/2016 | Access Monitoring Review Plan | Title: Access Monitoring Review Plan Run Dates: April 18, 2016 through May 19, 2016 PV Types: All CMS recently issued a final rule directing State Medicaid programs to analyze and monitor access to care for Medicaid Fee-for-Service programs. Through an access monitoring review plan, the State will demonstrate access to care by measuring the following: enrollee needs; the availability of care and providers; utilization of services; characteristics of the enrolled members, and estimated levels of provider payment from other payers. Please submit all comments by close of business, Thursday, May 19, 2016 via the policy change blog. Thank you for your participation in the process. |
| 4/4/2016 | LBHP-Under Supervision Contracts | Title: LBHP-Under Supervision Contracts PV Types: 53.536 Run Dates: March 31, 2016 thru May 31, 2016 Please NOTE: You cannot renew your existing contract as it is the LBHP specific contract. You must complete a NEW contract that is specific to the LBHP-Under Supervision provider type. This is a brand new Specialty Type. The system is ready for you to complete your contracts today. Please know that all LBHP-Under Supervision contracts must be completed by 5/31/2016. |
| 4/1/2016 | Additional Information for Provider Letter 2016-07 | Title: Additional Information for Provider Letter 2016-07 Run Dates: March 29, 2016 thru May 12, 2016 PV Types: All This message is to provide additional information contained in provider letter 2016-07. We did not include the current visit limits we have established while we determine the utilization of this type of visit. For now, members will be allowed one visit per month with a maximum of 4 visits per year. If a second visit is medically necessary in the same month, providers can request a prior authorization within 30 days from the date of service. If the prior authorization is approved, that visit counts against the yearly maximum. Please call the OHCA call center if you have additional questions at 1-800-522-0114. |
| 3/28/2016 | Provider Letter 2016-07 | Title: Dear Provider Letter 2016-07 Run Dates: 3/28/16-5/11/16 PV Types: 031, 052, 072, 080, 081, 082, 088, 092, 093, 100, 184, 185 Provider letter 2016-07 serves to inform providers on codes associated with virtual visits. Please post all comments by close of business, Friday, April 28, 2016 via the policy change blog. Thank you for your participation in the process. |
| 3/22/2016 | DME Codes moved from Max Fee Method to Manual Pricing | Title: DME Codes moved from Max Fee Method to Manual Pricing Run Dates: March 21, 2016 thru June 30, 2016 PV Types: 250 – DME/Medical Supply Dealers Two codes have been moved from MAX fee items to Manually Priced items effective January 1, 2016. Both codes will be processed as manually priced items. A4627 – Spacer Bag Reservoir will be paid at the lesser of MSRP -30% or Cost + 30% (less the 3 % Budget Reduction effective January 1, 2016) – invoices and proof of delivery must be attached to the claim for payment consideration E0638 – Standing Frame System will be paid at the lesser of MSRP -30% or Cost + 30% - the 3% reduction will not be applied to this code since it is classified as Complex Rehab Technology– invoices and proof of delivery must be attached to the claim for payment consideration. Contact Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org for additional clarification. |
| 3/16/2016 | Provider Letter 2016-06 | Title: Provider Letter 2016-06 Run Dates: 3/16/16-4/29/2016 PV Types: 02, 31, 80, 81, 82, 84, 90, 91, 92, 93, 100, 184, 185, 192, 195, 197, 199, 240, 316, 318, 319, 322, 329, 341, 344, 345, 355, 356, 359, 526, 540 Provider letter 2016-06 serves to inform providers on prior authorization for medications Neulasta, Granix, and Zarxio. Please post all comments by close of business, Friday, April 15, 2016 via the policy change blog. Thank you for your participation in the process. |
| 3/7/2016 | Prior Authorizations | TITLE: Prior Authorizations RUN DATE: 3/3/16 – 4/18/2016 PV Types: All Prior Authorizations (PAs) are reviewed based on medical necessity and must be submitted by providers who are contracted with SoonerCare. 42 CFR § 455.410 requires all ordering or referring physicians, or other professionals providing services under the State plan or under a waiver of the state plan, to be enrolled as a contracted provider with SoonerCare. It will be the responsibility of the Servicing Provider to verify that each order received is from an ordering/referring SoonerCare provider prior to submitting for Prior Authorization. Reminder, Prior Authorization is not a guarantee of payment. If you have questions regarding the PA process, please contact the OHCA Call Center toll free at (800) 522-0114 or, in Oklahoma City, call (405) 522-6205. |
| 2/29/2016 | Member Applications down for maintenance | Title: Member Applications down for maintenance Run Dates: 2/29/16-4/15/2016 Provider Type 1 and 11 Provider Type 1: NODOS and eNBI application systems will be down for maintenance between 6 pm Friday March 4 – 8 am Monday March 7, 2016. Provider Type 11: ODMHSAS application system will be down for maintenance between 6 pm Friday March 4 – 8 am Monday March 7, 2016. |
| 2/22/2016 | PPR Reports | TITLE: PPR Reports Run Dates: 02/19/2016 – 04/01/2016 PV Types: 01 – Hospitals 010 – Acute Care 011 – Psychiatric 012 – Rehabilitation 013 – Residential Treatment Center 014 – Critical Access 015 – Children’s Specialty 016 – IHS Hospital OHCA recently distributed by email Hospital Potential Preventable Readmissions (PPR) data for CY 2014 which is informational only. A summary document may have been attached and may show a penalty but it is to illustrate the methodology only, penalties will NOT be assessed related to the CY 2014 data. Soon, the CY 2014 data will be accessible on the provider portal. To access, follow these steps after you have logged into the Provider Portal: From the Provider’s My Home Page, select the Reports tab. Click on the link called Provider Reports. Select the Report name from the Report Title dropdown. Select the Report Year from the Report Year dropdown. Click Search. OHCA will make CY 2015 Hospital PPR data available on the provider portal in April 2016. The penalty per hospital will vary and will be collected in the quarter ending June of 2016. Per diem facilities (Freestanding Psychiatric Hospitals, Psychiatric Residential Treatment Facilities, IHS/Tribal) are included in the analysis but excluded from penalties, so these facilities may receive informational only data related to the program, but penalties will NOT be assessed. |
| 2/18/2016 | Lemtrada® (alemtuzumab) J0202 | TITLE: Lemtrada® (alemtuzumab) J0202 Run Date: 02/16/2016 – 04/01/2016 PV Types: All Lemtrada® (alemtuzumab) requires a prior authorization when billed through a physician or outpatient claim via J code, J0202. Lemtrada® is not available through the SoonerCare pharmacy benefit. The prior authorization criteria are below and can be found in the Central Nervous System section at www.okhca.org/pa. |
| 2/18/2016 | High Risk Obstetrical Services CH-17 Form Update | Title: High Risk Obstetrical Services CH-17 Form Update Effective 02/09/2016 Run Date: 02/10/2016 – 04/30/2016 PV Types: 31 - Physician 091 - OB Nurse Practitioner 181 - Maternity 199 - OB/GYN Group 214 - High Risk Pregnant Women 316 - Family Practitioner 318 - General Practitioner 328 - Obstetrician/Gynecologist 335 - Maternal Fetal Medicine 564 - Primary Care Provider Form CH-17 for High Risk Obstetrical Treatment Plan/Prior Authorization Request has been updated to allow modifiers for twins and triplets. 1. Providers may request up to 3 units (combined) for 76815 + 76816 + 76817 for each fetus. Modifiers 26 & TC selected together per code count as 1 unit; circle/check 59 modifier for twins, 59 & 76 modifiers for triplets. 2. Providers may request up to 5 units (combined) for 59025 + 76818 + 76819 for each fetus. Modifiers 26 & TC selected together per code count as 1 unit; circle/check 59 modifier for twins, 59 & 76 modifiers for triplets. For information regarding requirements and submission of a Prior Authorization request for High Risk Obstetrical services, please view the Medical Authorization Unit public webpage at www.okhca.org/mau, select High Risk OB (HROB)link. Also refer to OHCA policy 317:30-5-22.1 Enhanced services for medically high risk pregnancies [Revised 09-01-15]. Forms may be accessed on the OHCA public website at www.okhca.org under the Providers section. If you have additional questions please call the OHCA Call Center Provider Helpline at (800)522-0114. |
| 2/17/2016 | Modified Stage 2 Delay | Title: Modified Stage 2 Delay Run Dates: 02/16/2016 – 04/01/2016 PV Types: 31, 52, 09, 27, 10 Due to unforeseen circumstances, the Modified Stage 2 changes will not be available until March 3. We apologize for any inconvenience. If you have any questions or need more information regarding the delay, please contact the EHR Incentive Team at 405-522-7347, okehrincentive@okhca.org or visit our website: www.okhca.org/ehr-incentive. |
| 2/12/2016 | EHR Attestation – Go Live | TITLE: EHR Attestation – Go Live Run Date: 02/12/2016 – 04/01/2016 PV Types: 09 – Advance Practice Nurse 10 – Mid-Level Practitioner 27 – Dentist 31 – Physician 52 – State Employed Physicians As the Oklahoma Health Care Authority is in the process of updating its EHR attestation system per the regulations outlined in the Modified Stage 2 final rule, we have developed a document to outline the changes. OHCA is working diligently to have these changes implemented as soon as possible. Our anticipated go live date is February 18, 2016. For program year 2015 only, the attestation tail period will be extended through May 31, 2016. |
| 2/11/2016 | Medicaid Dental Documentation Seminar | Title: Medicaid Dental Documentation Seminar Run Date: 02/11/2016 – 04/01/2016 PV Types: 27 Dentist Spc: 086 – Dental Clinic 271 – General Dentistry Pract 272 – Oral Surgeon 273 – Orthodontist 274 – Pediatric Dentist The OHCA invites all dental providers to attend the Medicaid Dental Documentation Seminar that will be held in: Tulsa, March 4 & 5; OKC, March 18; and, Lawton, March 19. This presentation will provide a framework for better understanding Medicaid requirements, SoonerCare policy and problem areas related to records and billing reviews. Please register for these trainings at the link below http://www.okhca.org/providers.aspx?id=110&parts=7557_7559 |
| 2/9/2016 | Board Agenda Change | TITLE: BOARD AGENDA CHANGE RUN DATES: 2/09/2016 - 3/23/2016 PV Types: 08, spec 193 53 All Specialties The proposed emergency rule identified as WF# 16-01 regarding reimbursement for Master’s prepared licensed behavioral health professionals in independent practice is being removed from the February 11 OHCA Board meeting agenda. Instead, the proposed rule will be presented as a permanent rule and will be presented at a public hearing April 1, 2016 at 9:00 a.m. followed by an OHCA Board meeting at 1:00 p.m. For more information on this and other proposed rules, visit www.okhca.org/policyblog. |
| 2/4/2016 | Reminder of Federal Requirements | TITLE: Reminder of Federal Requirements RUN DATES: 02/04/2016 – 03/27/2016 PV Types: All REMINDER OF FEDERAL REQUIREMENTS FOR SUBMITTING CLAIMS FOR SERVICES PROVIDED TO SOONERCARE MEMBERS. 42 CFR § 455.410 requires all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the state plan to be enrolled as a contracted provider with SoonerCare. In addition, 42 CFR § 455.440 further requires that all claims for payment for items and services that were ordered or referred to contain the National Provider Identifier (“NPI”) of the physician or other professional who ordered or referred such items or services. We have modified our claims processing system accordingly. As a result, effective immediately, claims filed electronically with OHCA will be denied unless the claim complies with these requirements. |
| 2/3/2016 | Provider Letter 2016-04 | Title: Dear Provider Letter 2016-04 PV Types: 09, 10, 31, 52, 80, 81, 82, 84, 184, 185, 195 Provider letter 2016-04 serves to inform providers on prior authorizations for medications used to treat breast cancer. Please post all comments by close of business, March 4, 2016 via the policy change blog. Thank you for your participation in the process. |
| 1/15/2016 | OKDMHSAS Proposed Changes | Title: OKDMHSAS Proposed Changes RUN DATES: 01/15/2016 – 02/28/2016 PV TYPES: ALL On January 13, 2016 the Department of Mental Health and Substance Abuse Services notified the Oklahoma Health Care Authority and members of the Behavioral Health Advisory Council of the following proposed changes. Elimination of Private individual Licensed Behavioral Health Providers including those participating in a Behavioral Health Group. Additional information can be found at http://okhca.org/PolicyBlog.aspx. These changes are necessary to reduce the Agency’s spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated. |
| 1/11/2016 | Follow-up to Provider Letter 2016-01 | Title: Follow-up to Provider Letter 2016-01 Run Date: 01/06/2016 – 02/21/2016 PV Types: All Per Provider Letter 2016-01, with the implementation of HCPCS G0477-G0483, OHCA would not expect to see non-specific pathology/laboratory CPT codes billed in addition to the HCPCS codes for presumptive or definitive drug testing. These CPT codes include, but are not limited to: 80299, 82542, 83516, 83518, 83519, 83520, 83789, 84311 and 84999. If any of these CPT codes are billed as part of a service that is separate from presumptive or definitive drug testing, then documentation in the record should reflect the indication for ordering these tests. If these codes are paid along with the HCPCS codes noted above for drug testing alone, this is considered unbundling and is subject to recoupment. HCPCS codes G0480 through G04383 are the only codes a provider should submit for reimbursement when performing definitive drug testing. Please refer to the definitive drug classes listing in CPT for further clarification. |
| 1/5/2016 | Provider Letter 2016-01 | Title: Dear Provider Letter 2016-01 Run Date: 01/05/2016 – 02/20/2016 PV Types: 01, 08, 09, 10, 11, 28, 31, 52 Provider letter 2016-01 serves to update providers on controlled substance monitoring and drugs of abuse testing. Please post all comments by close of business, February 4, 2016, via the policy change blog. Thank you for your participation in the process. |
| 1/4/2016 | NH Crossover Payments | Title: NH Crossover Payments Run Date: 01/01/2016 – 02/20/2016 PV Type: Nursing Homes: 03-Extended Care Facility 030 Nursing Facility 031 ICF/MR > 6 Beds 032 Pediatric Nursing Facility 033 Residential Care Facility 034 ICF/MR < 6 Beds 035 Skilled Nursing Facility 036 Respite Care - Facility Based 037 Assisted Living Effective January 1, 2016, the payment for Nursing Home Crossovers Part A, co-insurance and deductibles will be reduced from 75% to 20%. |
2016 Global Messages
Last Modified on
Nov 19, 2020
