Subject:  Changes to Infectious Disease Laboratory Testing

Effective December 1, 2018, the Oklahoma Health Care Authority (OHCA) will no longer cover the following Current Procedural Terminology (CPT) codes for infectious disease testing:

Infectious agent detection by nucleic acid (DNA or RNA);

·         87472  Bartonella henselae and Bartonella quintana, quantification

·         87482  Candida species, quantification

·         87487  Chlamydia pneumoniae, quantification

·         87492  Chlamydia trachomatis, quantification

·         87512  Gardnerella vaginalis, quantification

·         87525  Hepatitis G, direct probe technique

·         87526  Hepatitis G, amplified probe technique

·         87527  Hepatitis G, quantification

·         87542  Legionella pneumophila, quantification

·         87552  Mycobacteria species, quantification

·         87557  Mycobacteria tuberculosis, quantification

·         87562  Mycobacteria avium-intracellulare, quantification

·         87582  Mycoplasma pneumoniae, quantification

·         87592  Neisseria gonorrhoeae, quantification

In addition, CPT code 87530 (Herpes simplex virus, quantification) will be limited to coverage for member ages 0-1 year only.

If you have any questions about this change, please call the OHCA Provider Helpline at 1-800-522-0114.

The year-end C-section rate letters for state fiscal year 2018 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.     

If you need help to retrieve your letters, please call 800-522-0114, Choose option 1 for questions concerning the Portal.     

You may also view the C-section rate release schedule on the OHCA webpage at www.okhca.org/c-section.

You and your staff are invited to attend the Fall 2018 SoonerCare Provider Training Workshops.     

Topics include: Provider Portal Utilization, Focus Forward Oklahoma (LARC training), Medical Authorizations Using InterQual^®, SoonerCare Population Care Management Services, Submitting Authorizations in PICIS, SoonerCare School-based Services, the HPV Vaccine in Cancer Prevention, the Oklahoma Tobacco Helpline, and more.    

Complete class descriptions and registration information are available at http://www.okhca.org/provider-training. Lawton, OK will be the first stop on Sept. 27, followed by Durant (Oct. 4), Tulsa (Oct. 10-11), Guymon (Oct. 17) and OKC (Oct. 24-25). 

Classes fill up fast, so mark your calendar and REGISTER NOW! 

Provider letter 2018-13 serves to inform I/T/U providers about a change to revenue code 513 (Behavioral Health Encounters). In addition, a new revenue code  528 (Off-site Services Encounters) – goes into effect Sept. 1, 2018. 

Please post all comments by close of business Aug. 23, 2018, via the Oklahoma Health Care Authority (OHCA) Policy Change Blog: http://okhca.org/PolicyBlog.  

Thank you for participating in this process.

The Centers for Medicare & Medicaid Services (CMS) requires internal control procedures for non-emergent transportation providers. To comply, LogistiCare (SoonerRide) will now be calling a small number of randomly-selected SoonerCare providers and members on a daily basis.  These calls are to confirm whether a SoonerCare member was seen by you, as a patient, on a specific date and time.    

Please instruct your staff to cooperate with the LogistiCare representative by checking your records. LogistiCare representatives will identify themselves and the purpose of the call.

LogistiCare has a signed HIPAA agreement with the Oklahoma Health Care Authority (OHCA), and OHCA has authorized them to conduct these daily surveys. The survey will now be part of their required daily activities.

If you have any questions about these surveys, please call the OHCA Provider Helpline: 800-522-0114.   

We thank you in advance for your cooperation.

For 835 remittance advice receivers - The Oklahoma Health Care Authority (OHCA) is aware of a few instances in which the 835 remittance advice Remarks Code for a claim detail may be repeated. OHCA will implement system changes on 07/21/2018 to stop this from occurring. This will affect the LQ Health Care Remarks Code segment.   

No coding changes are expected for this change.

C-section rates letters for the third quarter of state fiscal year 2018 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.    

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Provider Helpline.    

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.    

Long-term care provider cost reports for state fiscal year (SFY) ‘18 are due to the Oklahoma Health Care Authority (OHCA) by Oct. 31, 2018.  

Facilities may be subject to a rate reduction equal to the amount of the direct care portion of the daily rate, if OHCA does not receive cost reports in a timely manner. Possible reductions range from $14.39 to $31.59 per patient day.   

Thank you for your attention to this matter.  

RE: Provider Letter 2014-13 

Title: Therapy-related parental participation 

At this time, Provider Letter 2014-13 – requiring parental/caregiver involvement in outpatient therapy for children enrolled in SoonerCare - is being retracted effective June 19, 2018. This affects physical, occupational, speech and hearing services. 

Effective Jan. 1, 2018, the Oklahoma Health Care Authority (OHCA) eliminated prior authorization requirements for certain electroencephalogram (EEG) procedures when performed in the emergency room or while a member is inpatient. This change affects CPT codes 95950, 95951, 95953 and 95956. 

We are hopeful this change will help providers serve our members more quickly and efficiently; however, the OHCA will continue to monitor claims for overutilization, waste and/or abuse. 

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114. 

Effective Aug. 1, 2018, the Oklahoma Health Care Authority (OHCA) will implement a change to the addenda record attached to your EFT (Direct Deposit) payment. This change will affect only the addenda record at the end of the EFT payment, and not the payment itself. 

Today the addenda record for payments made by SoonerCare are as follows:

TRN*1*20180801*0000123456*1*00123456*73-1476619* 

(TRN * 1 * Payment (Deposit) date * Warrant (Payment) number * 1 * Warrant (Payment) amount with two decimals implied * Oklahoma Health Care Authority’s Federal Tax ID Number (containing a dash.))

Once the change goes into effect, the addenda record for payments made by SoonerCare will read: TRN*1*00123456*1731476619* 

(TRN *1* + warrant [payment] number +*1, followed by OHCA’s Federal Tax ID Number [containing no dash] + *)  

PLEASE NOTE: It is important that you contact the financial institution where your SoonerCare payments are deposited and notify them of this upcoming change. Doing so will help to ensure your EFT payments received beginning Aug. 1, 2018, will process properly and will not delay your funds availability.

Effective June 4, 2018, the Oklahoma Health Care Authority (OHCA) will embed InterQual® evidence-based questions and answers for certain imaging and pain management prior authorization (PA) requests into the SoonerCare Provider Portal PA function. This is the second phase of our InterQual® implementation, as previously described in Provider Letter 2017-35.   

The transition will take place during the next 12 months and will include most medical PA requests^*.

Also effective June 4, 2018, the OHCA will implement near real-time adjudication (15 minutes or less) for certain imaging study PAs. To accomplish this, imaging PAs will require electronic attachments upon submission that support the PA request.

The InterQual® process and adjudication changes will be covered in the spring Provider Training events being held in May and June. We encourage all medical providers to sign up for a training session near them in order to prepare for these upcoming changes. You can sign up on the OHCA Training webpage.

If you have any questions about these PA process changes or the InterQual® implementation, please call the OHCA Provider Helpline at 1-800-522-0114.  

* As a reminder: Approved PAs are not a guarantee of payment due to a variety of reasons (such as eligibility, etc.).

As a reminder, effective November 1, 2017, the Oklahoma Health Care Authority (OHCA) no longer issues member ID cards. This is part of our continuing efforts to be fiscally responsible and reduce paper usage.    

However, if a physical member ID card is requested, members have the ability to print cards from their Member Portal. 

As an added convenience, providers also have the option to print ID cards from the SoonerCare Provider Portal. To do so, simply log on and select the Eligibility Tab, verify the member’s eligibility, and then select “Display Member ID Card.”  If the member does not currently have eligibility, this button will not display.

If you have any questions about this new process, please call the OHCA Provider Helpline at 1-800-522-0114.

Effective 4/1/18, CPT 27279 - Arthrodesis of the SI joint, percutaneous or minimally invasive approach - will be reimbursable. The OHCA has determined there is sufficient evidence to support this code; however, prior authorization is required (as is CPT 27280, Arthrodesis of the SI joint, open approach).     

Current pricing of this procedure is $580.66 per our physician fee schedule. APC Payment Group = A5116 and is priced at $10,987.99; the ASC reimbursement is $9,664.16.

C-section rates letters for the second quarter of state fiscal year 2018 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.      

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Provider Helpline.  

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.  

Effective 04/07/2018, the Oklahoma Health Care Authority (OHCA) will implement system changes in an effort to return more relevant adjustment reason codes for claim denials. These changes will affect 835 remittance advice receivers and apply to the claims adjustment segment (CAS) of the 835. 

Please make any necessary adjustments to ensure that the CAS can handle up to six claim adjustment reason codes within the segment. 

Provider letter 2018-04 serves to inform providers on the prior authorization for Microarray Current Procedural Terminology (CPT) codes, effective May 1, 2018. Please post all comments by close of business Monday, April 23, 2018, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

Effective January 1, 2018, the Oklahoma Health Care Authority (OHCA) increased the reimbursement rate for Dental Procedure Code (CDT) D9999 from $274.95 to $895.00, and the reimbursement rate for the procedures in APC Group A5164 from $1,197.60 to $895.00. These changes will help to increase the types of services and care our members can receive at outpatient facilities.

For more information about this rate change or if you have any questions, please call the OHCA Provider Helpline at (800) 522-0114.

Provider Types 25

Provider Letter 2018-03 serves to inform providers about the rate change regarding reimbursement for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) products and services, effective April 1, 2018 . Please post all comments by close of business Thursday, April 5, 2018, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you for your participation in the process.

As previously posted, effective January 1, 2018, the Oklahoma Health Care Authority (OHCA) began to only pay care coordination fees for members who have visited their assigned provider within the past 15 months. This includes Insure Oklahoma providers.

To assist providers in identifying members who have not established a provider-patient relationship, OHCA will furnish medical home providers a listing of members who have either not established this relationship or are within 45 days of reaching the 15-month mark. This report is called the Initial Visit Report for Care Coordination Payment and is located under the Financial tab in the secure Provider Portal.

For your convenience, an informational webinar will be held on Thursday, Feb. 15, 2018, at 2 p.m. Registration for this webinar can be found on the Provider Training page on the OHCA public website. For more information, please contact OHCA Provider Services at 800-522-0114, option 1.

Thank you for your continued support of SoonerCare.

Following months of speculation, the Oklahoma Health Care Authority (OHCA) is pleased to inform you that Congress has reauthorized funding for the Children’s Health Insurance Program (CHIP). OHCA uses CHIP funds to operate the Soon-to-Be-Sooners program and to cover children under Insure Oklahoma Employer-Sponsored Insurance (ESI - Child).

Previously we posted a global message informing you that these CHIP-only programs were in jeopardy of termination without the renewal of funding, meaning your patients would lose eligibility. The reauthorization on January 22 means those terminations will not happen. Both STBS and ESI – Child will continue without interruption.

If you or your patients would like to learn more about CHIP, please visit www.okhca.org/chip for the latest information.

Thank you for your patience and your continued service to our members.

C-section rates letters for the first quarter of state fiscal year 2018 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.    

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Provider Helpline. Choose option 1 for questions concerning the Portal.     

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.