Thank you.

Provider Letter 2019-24 serves to inform providers about the prior authorization for certain molecular pathology CPT codes, effective Jan. 1, 2020. Please post all comments by close of business Thursday, Jan. 2, 2020, via the Oklahoma Health Care Authority policy change blog. Thank you.

The webinar will cover important changes in federal regulations and state rules that have resulted in SoonerCare policy modifications for out-of-state services. All three types of existing out-of-state services will be reviewed, and new changes will be presented.

Register here to attend the "What's New in Out-of-State Services" webinar:

Expired Link.

The webinar will cover important changes in federal regulations and state rules that have resulted in SoonerCare policy modifications for out-of-state services. All three types of existing out-of-state services will be reviewed, and new changes will be presented.

Register here to attend the “What’s New in Out-of-State Services” webinar: https://okhca.org/xwebinars.aspx.

CMS has approved the Applied Behavior Analysis State Plan Amendment request that was submitted on June 26, 2019. Effective Oct. 7, 2019, SoonerCare contracted Board Certified Behavior Analysts who have received prior authorization for ABA services, may submit or resubmit claims for payment of services rendered on July 1, 2019 and thereafter. Timely filing requirements must be met to receive reimbursement.

The Oklahoma Health Care Authority will be submitting a new SPA request to the Centers for Medicare & Medicaid Services to recognize Registered Behavior Technicians as an Oklahoma Medicaid provider type, and to allow for coverage of RBT services with a requested effective date of Jan. 1, 2020. Additionally, corresponding RBT agency rules must also be promulgated and receive approval by the Governor before OHCA can begin coverage of and reimbursement for ABA services provided by RBTs. No claims can be billed under the 97153 RBT CPT code until the SPA and the agency rules are approved.

All RBTs interested in providing compensable ABA services to SoonerCare members under age 21 are required to apply and be approved for a provider contract with OHCA. Interested RBTs can begin enrolling as a SoonerCare RBT provider on Nov. 18, 2019; the contract’s effective date will be Jan. 1, 2020.  Individuals may apply by completing the RBT application. In order to complete your application, you will be required to upload a copy of your national RBT certification. RBTs must work under the supervision of a SoonerCare contracted BCBA.  Please note, if you are currently contracted with OHCA to provide other compensable services to SoonerCare members, you will be required to have a separate contract for ABA services. To begin enrollment, please access the following link: https://www.ohcaprovider.com/Enrollment/(S(dpch43qo4ndvkoprsvpysme2))/Site/Home/createuser.aspx

If you have any questions regarding contracting, please call 800-522-0114, option 5, or email ProviderEnrollment@okhca.org, to receive assistance.

Our first Stakeholders webinar and in-person meeting was held on September 17th at 9:30 AM.  Additional stakeholders meeting are scheduled for October 22nd in Tulsa and October 23rd in Oklahoma City.  There is also an option to attend via webinar on October 23rd.  We will be providing additional details regarding the new design, answering questions and requesting your input. You can download the PowerPoint Presentation here.

Please register using the links below: 

Tulsa

• Date/Time: Tuesday 10/22/2019 from 2:00 p.m. – 4:00 p.m. 
• Location: OSU CHS A.R. and Marylouise Tandy Medical Building, 1111 W. 17th St, Tulsa, OK 74107
• Meeting Registration Link: https://www.eventbrite.com/e/pcmh-redesign-october-2020-stakeholder-input-tulsa-tickets-74427449505

• Date/Time: Wednesday 10/23/2019 from 2:00 p.m. – 4:00 p.m.
• Location: Oklahoma Health Care Authority, Charles (Ed) McFall Boardroom, 4345 N. Lincoln Blvd, Oklahoma City, OK 73105
• Meeting Registration Link: https://www.eventbrite.com/e/pcmh-redesign-october-2020-stakeholder-input-oklahoma-city-tickets-74432041239  
• Webinar Registration: Expired Link.

Provider Types:  08, 10, 31, 52

It is recommended pediatric primary care providers use a standardized tool to screen infants and toddlers at 9, 18, 24 or 30 months. It is also recommended an Autism-specific screening be performed at 18 or 24 months based on the AAP Bright Futures latest edition.  The use of a standardized screening tool is also appropriate at other times if concerns are identified through routine surveillance or parental/caregiver concerns are raised.

Documentation of the screening must include the screening tool used, the results of the screen, any referrals needed or made, and follow up care or recommendations.  The screening documentation must be separate from documentation related to other services performed that day and must be appropriately signed by the rendering practitioner.

Thank you.

Effective October 1, 2019, prior authorization requirements will be removed for adult and pediatric echocardiograms with CPT codes: 93303, 93304, 93306, 93307, and 93308.

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

Thank you.

This Stakeholders meeting will be held on September 17th at 9:30 AM. We will be providing additional details regarding the new design, answering questions and requesting your input.

You can attend in person at this location:

OHCA
Beavers Bend Conference Room
4345 N. Lincoln Blvd., OKC, OK 73015

Or to attend the meeting via webinar, please register here: Expired Link.

An additional forum will be hosted in early October.

Effective 8/1/2019, OHCA will add coverage for G0296 - counseling visit to discuss need for lung cancer screening using low dose computed tomography scan (LDCT) (service is for eligibility determination and shared decision making). This service is covered for ages 55-77 with a limit of one time per calendar year.

OHCA follows the Centers for Medicare and Medicaid (CMS) National Coverage Determination (NCD) requirements for this visit. CMS NCD 210.14

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have questions about this new coverage.

Pursuant to Oklahoma Administrative Code 317:30-3-65.12, effective July 1, 2019, all Board Certified Behavior Analysts (BCBAs) interested in providing compensable services to SoonerCare members ages 21 and younger are required to apply and be approved for a provider contract with the Oklahoma Healthcare Authority (OHCA). Individuals will apply by: accessing OHCA’s provider portal; selecting “Applied Behavior Analyst” as the provider type; and then selecting either Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA) as the specialty. In order to complete your application, you will be required to upload a copy of your national certification (licensed human services professionals), license or certificate issued by DHS on behalf of the Oklahoma Licensed Behavior Analyst Board (BCBAs, BCaBAs, and unlicensed human services professionals), and/or human services professional license (licensed human services professionals), if applicable. Please note, if you are currently contracted with OHCA to provide other compensable services to SoonerCare members, you will be required to have a separate contract for ABA services. To begin enrollment, please access the following link: https://www.ohcaprovider.com/Enrollment/(S(dpch43qo4ndvkoprsvpysme2))/Site/Home/createuser.aspx. If you have any questions regarding contracting, please call 1-800-522-0114 option 5, or email ProviderEnrollment@okhca.org, to receive assistance.

For further information regarding CPT codes, prior authorization, and location of ABA templates please visit the following link:
http://www.okhca.org/providers.aspx?id=23614

Provider Letter 2019-08 serves to inform providers about changes being made to prior authorization requirements for medication assisted treatment. Please post all comments by close of business Friday, August 23, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.  

We are seeking your input into the values, functionality and services of the statewide HIE. The survey will be open for two (2) weeks beginning July 8, 2019.  Once closed, the results of this survey will be evaluated and released via state agency websites. 

• Documentation of onset of symptoms <8 years of age in females and 9 years of age in males; AND
• Documentation that bone age is advanced 1 year beyond the chronological age; AND
• Lab assessment:
  • Documentation of abnormal basal gonadotropin levels; OR
  • Documentation of pubertal response to a gonadotropin-releasing hormone analog stimulation test; AND
• Approvals may be granted with documentation of failed trials of lower-tiered products or an FDA approved indication not covered by a lower-tiered product, such as Lupron Depot-Ped® and Triptodur®.  

If you have questions, please contact the Pharmacy Authorization Unit at (800) 522-0114, option 4.

Provider type: 27, Provider Specialty: 086, 271, 274, 278

The Oklahoma Health Care Authority (OHCA) is providing the following links as a resource to assist Providers in the billing and use of appropriate modifiers, specifically modifiers 25 and 59.   

Novitas Modifier 25

Novitas Modifier 59

• 52441 – UroLift cystourethroscope first implant
• 52442 – UroLift cystourethroscope each additional implant

C-section rate letters, for the second quarter of state fiscal year 2019, are now available through the OHCA Provider Portal. As a reminder, these C-section letters are only available electronically.    

If you need help retrieving your letters, please call the Provider Helpline at 800-522-0114 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.    

Thank you. 

• Q4102—Oasis Wound Matrix 
• Q4107—Graftjacket 
• Q4132—Grafix Core 
• Q4133—Grafix Prime 
• Q4186—Epifix  

Skin substitute products will require prior authorization (PA) along with documentation supporting medical necessity (as outlined in the Oklahoma Administrative Code (OAC) 317:30-3-1). For your review, OHCA’s Wound Care and Skin Substitute guidelines are posted on our website under Medical Authorization Unit which outline specific indicators for use.

The OHCA expects that in cases in which there are multiple sizes of products available, the size that best fits the wound with the least amount of waste, at the LESSER cost, will be utilized.

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have any questions about this new coverage.

Title: CPT 87150 Reimbursement Change

Effective February 15, 2019, the Oklahoma Health Care Authority (OHCA) will only reimburse for CPT 87150 (culture typing; identification by nucleic acid [DNA or RNA] probe, amplified probe technique, per culture or isolate, each organism probed) in the outpatient hospital setting.   

Please note: When this service is performed in the inpatient setting, reimbursement is included in the DRG payment.   

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

Title: Electronic Inpatient and Discharge Notifications

Inpatient admission and discharge letters are now available on the SoonerCare Provider Portal. You can find them under the Letters tab. Previously faxed, the inpatient admission and discharge letters are now only available electronically. This change only affects PCMH providers.

Title: Dear Provider Letter 2019-01

Provider Letter 2019-01 serves to inform providers about policy regarding laboratory and diagnostic testing. Please post all comments by close of business Monday, February 24, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.

TITLE: Vaccine Administration Documentation

The Oklahoma Health Care Authority routinely reviews medical records in association with other business processes. The reviewers have noticed a lack of required information pertaining to vaccine administration and would like to remind providers of the required medical record documentation as per the CDC and ACIP recommendations. This information can be found at https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html#documentation   

All vaccines administered should be fully documented in the patient’s permanent medical record. As per the requirements of the National Childhood Vaccine Injury Act and best practice, documentation should include the following:

• date of administration 
• vaccine manufacturer 
• vaccine lot number 
• name and title of person who administered vaccine and address of facility where permanent record will reside 
• vaccine information statement (VIS) 
• date on VIS 
• date provided to patient or parent/guardian 
• vaccine type (ACIP abbreviation) 
• route 
• dosage (volume) 
• site 
• document vaccine refusal 

Please contact the OHCA Provider Helpline at 1-800-522-0114 with any questions or concerns.  

  TITLE: C-Section Rates Letters 

C-section rate letters for the first quarter of state fiscal year 2019 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,for the Provider Helpline. 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.    

Thank you.