Global Messages

Provider Types: All

OHCA has opened coverage for the following COVID-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA:

91300 – Pfizer BioNtech Covid-19 vaccine (effective date 12/11/2020) 

0001A – Pfizer BioNtech Covid-19 vaccine administration – first dose
0002A – Pfizer BioNtech Covid-19 vaccine administration – second dose

91301 – Moderna Covid-19 vaccine (effective date 12/18/2020)

0011A – Moderna Covid-19 vaccine administration – first dose
0012A – Moderna Covid-19 vaccine administration – second dose

OHCA has opened coverage for the following COVID-19 monoclonal antibodies and administration when used in accordance with the emergency use authorization from the FDA. Monoclonal antibody infusion is reimbursable when provided in a hospital outpatient department or physician’s office experienced in infusion services. Due to the risk of anaphylaxis, treatment should only be administered in settings where health care providers have immediate access to medications to treat a severe infusion reaction and the ability to activate the emergency medical system as needed. 

Q0239 – Injection, bamlanivimab, 700 mg (Eli Lilly) (effective date 11/09/2020)
M0239 – Intravenous infusion, bamlanivimab-includes infusion and post administrative monitoring (Eli Lilly) (effective date 11/09/2020)

Q0243 – Injection, casirivimab and imdevimab, 2400 mg (Regeneron) (effective date 11/20/2020)

M0243 – Intravenous infusion, casirivimab  and imdevimab includes infusion and post administrative monitoring (Regeneron) (effective date 11/20/2020)

If you have any questions, please call the OHCA provider helpline at 800-522-0114.

42 CFR § 455.440 requires all payment claims for items and services that were ordered or referred to contain the National Provider Identifier of the physician or other professional who ordered or referred such items or services. 

You only need to bill with the ordering NPI if it is required. If the ordering provider NPI has multiple locations, include the ZIP +4.

OHCA will be presenting a webinar titled Special Claims Process - ADA Dental on Tuesday, Nov. 17, 2020 at 2:00 p.m. This class is an overview of the recent Special Process feature now included on the provider portal for providers who bill on an ADA Dental claim type. As OHCA continues the Going Green initiative, if a claim requires Special Processing, this action can now be completed and submitted on the SoonerCare provider portal. We will discuss and demonstrate the process of completing a claim for Special Processing via the provider portal. This class will not cover policy or other types of claim submission.

Register to attend the Special Claims Process – ADA Dental webinar on November 17: Expired Link.

The US Dept. of Health and Human Services has extended the public health emergency through Jan. 21, 2021. 

The public health emergency renewal is posted at: https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-2Oct2020.aspx.

What does this mean for SoonerCare providers and members?

• Expanded use of telehealth services through Jan. 31, 2021 for most SoonerCare services.
• OHCA and DHS will not terminate SoonerCare coverage for members during this time.
• No cost sharing for testing or treatment of COVID-19 for SoonerCare members.
• Some medicines may be prescribed for 90-days to reduce trips to the pharmacy.

Provider Types – 08, 17, 087, 170, 171, 173, 174, 175, 182 

Therapy providers will identify whether a service was performed via outpatient or telehealth when a claim is submitted for reimbursement. Providers will choose either a Place of Service (POS) 11 for therapy performed in office or a POS 02 for therapy performed via telehealth.   

For therapy PAs currently approved with a GT modifier line, continue submitting claims with a GT modifier through Oct. 30, 2020 if the service was performed via telehealth. All therapy services provided on or after Oct. 31, 2020 will bill with a POS 11 for therapy performed in office or a POS 02 for therapy performed via telehealth. 

Please be aware OHCA has revised the Caries Risk Assessment (CRA) and the DEN-2 Orthodontic Referral Form.

The CRA now consists of two forms – 1) Ages 0-6 years and 2) Age 7 and older.The DEN-2 has been revised to include the NPI of the referring dental provider. A recent global message informed orthodontic providers that they are now required to add the referring dentist’s NPI on any D8080 claim.

All forms are listed on the OHCA public website.

317:30-5-700. Orthodontic services

[Revised 09-01-16]

(a)In order to be eligible for SoonerCare Orthodontic services, members must be referred through a primary care dentist; a member can receive a referral from a primary care dentist to the orthodontist.

Note: the OHCA public website will be covered in this class (www.okhca.org), NOT the SoonerCare Provider Portal.

HHS announced that eligible providers would be given another opportunity to submit their application for funds from the Provider Relief Fund. Examples of eligible Medicare, Medicaid, CHIP and dental providers include:

1. Providers who did not receive an initial payment that totals approximately 2% of their annual patient revenue.
2. Providers who did receive an initial payment but missed the June 3 deadline to submit their revenue information.
3. Providers who were ineligible for prior General Distribution funds due to a change in ownership or because they did not have Medicare fee-for-service revenue in 2019.
4. Providers who previously received Phase 1 General Distribution payment(s) but rejected and returned the funds and are now interested in reapplying.

The deadline for applying for funds is Aug. 28, 2020.

For the latest information on the Provider Relief Fund Program, visit: hhs.gov/providerrelief

Read the press release here: https://www.hhs.gov/about/news/2020/08/10/hhs-provider-relief-fund-phase-2-general-distribution-now-accepting-additional-applicants.html.

Effective Aug. 1, 2020, OHCA will open coverage of sleep studies for adults and will implement sleep study codes to run through InterQual guidelines that are embedded into the SoonerCare provider portal prior authorization function. Providers will now need to answer questions in InterQual and submit supporting documents. The use of InterQual guidelines began on Jan. 1, 2018. For details, refer to provider letter 2017-35 and 2017 Global Message dated Oct. 10, 2017, “Upcoming Changes to the Medical Authorization Prior Authorization Process.”. Home sleep studies codes 95800 and 95806 will also be opened for coverage for ages 21 and older through InterQual. The following requirements for reimbursement must be met:

1. The home sleep study must be provided by a Sleep Diagnostic Testing Facility (“Facility”) as defined in Section 7200.3(6) of Title 63 of the Oklahoma Statutes;
2. The home sleep study must be performed with a technically adequate device;
3. The Facility must have a supervising or an interpreting physician, a registered sleep technician or a licensed respiratory therapist specifically trained in the use of home study equipment, provide the member with face-to-face instructions in the correct use of the equipment; and
4. The Facility providing the study must provide 24-hour telephone support by a registered sleep technician or licensed respiratory therapist specifically trained in the use of home-study equipment.

Effective Aug. 3, 2020, providers will be able to check their contract application status with Oklahoma Health Care Authority through a link on the public website. The Check Application Status link can be found at www.okhca.org under the contracts section of the enrollment page. The application tracking number (ATN) and the FEIN or SSN from the contract will be required to access the information. If you have questions or need assistance, please call the provider helpline at 800-522-0114 or email providerenrollment@okhca.org.

The Oklahoma Health Care Authority will implement the DME to Home Health project changes August 1, 2020. The prior authorizations, covered items, limits, and opening/closing coverage to adults will be implemented on August 1, 2020. Pricing changes will be delayed until September 17, 2020.  After pricing changes are implemented, all paid claims with dates of service on or after August 1, 2020 will be reprocessed and adjusted.

Provider types/specialties: All

The U.S. Department of Health and Human Services renewed the national public health emergency effective from July 25 through Oct. 23, 2020. OHCA is allowing expanded use of telehealth through Oct. 31, 2020 for most reimbursable services. Read the HHS determination at https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-23June2020.aspx.

Dear SoonerCare provider,

The Oklahoma Health Care Authority is capturing diagnosis codes when submitted on a pharmacy claim as per National Council for Prescription Drug Programs billing standards. Pharmacy claims submitted using the NCPDP claim format can enter diagnosis codes in field 424-D0. Pharmacies are encouraged to enter the diagnosis code on a pharmacy claim anytime a diagnosis is written on a prescription. A pharmacist may document the diagnosis code on the original or electronic prescription if confirmed by the patient or the prescriber.

OHCA is encouraging the use of diagnosis codes on prescriptions for contraceptives. The diagnosis code is needed for OHCA federal reporting purposes for contraceptives billed as a pharmacy claim when used as family planning. At this time, the adjudication of the claims will not be affected. However, claims will be denied when a diagnosis is not entered for contraceptive claims in the future. OHCA will alert pharmacies prior to denying claims for contraceptives with no diagnosis. Acceptable diagnosis codes for contraceptives are listed below.

Provider types/specialties: All

OHCA and DXC will be updating their security settings on all of their websites. Please make certain you are utilizing a current browser (IE Version 7 or higher, Chrome 30 or higher, Firefox 24 or higher and Safari 7 or higher with TLS 1.2 ENABLED).

Users utilizing current browser versions should not have any issues accessing the sites. Older versions will need to be upgraded or TLS 1.2 security must be enabled for the secure sites to work appropriately.

Starting 7/31 you may not be able to access these sites if your browser is not TLS 1.2 enabled. We apologize for any inconvenience. If you have questions or need assistance, please call the provider helpline at 800-522-0114.

Provider types/specialties: 30, 35

Notice for providers submitting PASRR LTC-300R (Level I) forms:

We have a new option for providers submitting a corrected LTC-300R form.

You may fax the corrected form to 405-530-7111. Please write corrected at the top of the form so staff will know the form is not an original submission.

If you are struggling to submit an LTC-300R form electronically, we are aware of some technical difficulties and are working with the fiscal agent to get those problems fixed. If needed, you may fax the LTC-300R form to the fax number listed above.

When filling out a paper LTC-300R form, be sure to fill in all appropriate fields. The information should be typed or legible. A blank LTC 300R form may be found on the OHCA public website at: /content/sok-wcm/en/okhcaprovider/forms/pdflib/binder1.pdf.

Call the OHCA internet helpdesk at 800-522-0114 for technical assistance submitting the LTC-300R form, or if you need help setting up access to the provider portal.

Thanks for serving our members.

Provider types/specialties: 03/30, 31, 34, 35

This is a reminder to LTC providers that all cost reports for the State Fiscal Year ending June 30, 2020, will be due on or before Oct. 31.

You must report costs electronically via the OHCA provider portal, unless you are submitting a partial year cost report. However, if a change of ownership has occurred and you have an entire year of data available, then the two partial reports must be combined and entered on the provider portal.

A new field titled hours has been added to the outside professional LTC cost reporting section of the provider portal. All LTC providers who are required to report outside professional fees, must include total hours when entering an amount in the total cost column.

Thank you for the services you provide to SoonerCare members.

Provider types/specialties: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, 52

The Oklahoma Health Care Authority will implement the DME to Home Health project changes Aug. 1, 2020, contingent on CMS approval. There will be four separate webinars set up, two specifically for DME providers and two specifically for case managers. DME provider webinars have been set up and are now on the training page (/content/sok-wcm/en/okhca/providers/provider-training) and open for registration. Case manager webinars will be set up soon, please continue to watch the training page for these registrations.

Provider types/specialties: 195, 329, 355, 356

Provider letter 2020-03 informs providers about the prior authorization requirements for Lumoxiti, effective Aug. 1, 2020. Please post all comments by close of business Monday, Aug. 3 via the Oklahoma Health Care Authority policy change blog. Thank you.

Provider types/specialties: All

Medicaid and CHIP providers who missed the deadline to apply for CARES Act relief fund payments during the first general distribution will have another opportunity. The U.S. Department of Health & Human Services is planning another opportunity to apply for a provider relief payment equivalent to 2% of total net patient revenue. The timeline has not been released, and HHS is still reserving funds for the payments. HHS will provide guidance when the portal reopens at a future date. Providers who want to learn about the process and relief payments can participate in an HHS webinar at 3 p.m. this Wednesday. Click here to register: https://protect-us.mimecast.com/s/SnerCERBAoH3OXJNuNkZ86?domain=webex.webcasts.com. 

Provider types/specialties: All

OHCA previously opened coverage for telephonic visit CPT codes 99441-99443 and 98966-98968 to be effective during the COVID-19 public health emergency. As a reminder, per the code descriptions, codes 99441-99443 are billable when telephonic services are rendered by a physician, physician assistant or nurse practitioner, and 98966-98968 are billable when telephonic services are rendered by all other professionals. These services may be utilized in instances when the SoonerCare member does not have access to telehealth equipment, the service is necessary to the health and safety of the member, and the service can safely and effectively be provided over the telephone. During the public health emergency, services can be provided to a new or established patient.

Provider types/specialties: 03, 30, 31, 34, 35

A new field titled hours has been added to the Outside Professional LTC Cost Reporting section of the provider portal. All LTC providers who are required to report outside professional fees, must include total hours when entering an amount in the total cost column.

We thank you for your attention to this matter.

Provider types/specialties: 03, 25

Effective July 1, 2020, nursing home rates will have a one-time adjustment to the base rate. This is to account for long-term care facility providers’ procurement of durable medical equipment, supplies and appliances, including oxygen, from the open market. DME providers who are currently servicing members residing in a nursing facility will need to work with the facilities for reimbursement of equipment and supplies. These changes were previously posted for public notice on the OHCA public notices page, as well as the policy change blog.

Provider types/specialties: 01, 08, 09, 10, 16, 29, 31, 52

Effective July 1, 2020, OHCA will implement additional imaging codes to run through InterQual guidelines that are embedded into the SoonerCare provider portal PA function. Providers will now need to answer questions in InterQual and submit supporting documents. The use of InterQual guidelines began on Jan. 1, 2018. For details, refer to provider letter 2017-35, 2017-35 and global message dated Oct. 10, 2017 “Upcoming Changes to the Medical Authorization Prior Authorization Process”, 2017 Global Messages

Provider types/specialties: All

The U.S. Department of Health and Human Services will hold a webinar for Medicaid and CHIP providers on the distribution of CARES Act relief payments. HHS will walk through the process of applying for the provider relief funds. The webinars will be at 1 p.m. Thursday; register here: https://bit.ly/2Z0MBMH.

Provider Types: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, and 52

The Oklahoma Health Care Authority will delay the DME to Home Health project that was to be effective July 1, 2020. DME reimbursement will stay at the current rates. The agency is awaiting CMS review and approval for proposed changes and cannot move forward until the approval process is completed. OHCA continues to evaluate the proposed rates and any additional rate changes will be posted in accordance with the public notification process. The agency anticipates CMS approval by Sept. 30, 2020 and providers will be notified as soon as the new effective date is set.

On June 9, the U.S. Department of Health and Human Services announced additional distributions from the provider relief fund to eligible Medicaid providers.  

The Oklahoma Health Care Authority would like to encourage all Oklahoma SoonerCare providers to consider applying for these funds, even if they are unsure of their eligibility.  

For additional detailed information, please review the following webpages. 

https://www.hhs.gov/about/news/2020/06/09/hhs-announces-enhanced-provider-portal-relief-fund-payments-for-safety-net-hospitals-medicaid-chip-providers.html

https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html

The application form and the portal used to complete the application can be found here: https://www.hhs.gov/sites/default/files/medicaid-provider-distribution-application-form.pdf

https://cares.linkhealth.com/#/  

Provider types/specialties: All

Telehealth services that have been expanded during the COVID-19 national and state emergency are being extended through September 30th 2020. OHCA will assess the status of the COVID-19 pandemic toward the end of September to determine if the expansion should be extended.

Provider types/Specialties: 05, 16, 50, 51, 163

Effective March 1, 2020 and for only as long as the national emergency surrounding COVID-19 exists, private duty nursing providers will receive a higher rate of pay for PDN hours that result in over‐time rate of pay for nursing staff. The increase is to be applied only for persons with tracheostomies or who are ventilator dependent.

Providers should bill all PDN hours/units (T1000 CPT billing code), including overtime hours, via the normal electronic claims process. Providers will receive $32.68 per hour ($8.17 per unit) via this regular process.

A secondary payment mechanism is in place for providers to request supplemental payment for an additional $7.32 per hour/$1.83 per unit for OT hours. That process is as follows:

• Prepare HCA-66, Request for Expenditure – Private Duty Nursing Overtime form  
• Prepare itemized supplemental payment detail using the attached excel file
• Submit both items via secure email to: populationcaremgmtadminassistants@okhca.org

Questions may be directed to Carolyn Reconnu-Shoffner, Director, Population Care Management, at 405-522-7630, or Kim Downing, Care Management Supervisor, at 405-522-7145.

Please join us for the 2020 Spring Provider Training Workshop!

We are excited to offer these virtual webinar-based classes to keep our providers, office managers and their staff up-to-date on current changes and policies. We have classes for all provider types and class descriptions can be found at /content/sok-wcm/en/okhcaClasses. Please join us for these informational sessions starting Tuesday, June 2.

Register now: /content/sok-wcm/en/ohca/register.html.

OHCA has recently added coverage for the following additional COVID-19 laboratory testing codes:

87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome                     

              Coronavirus 2 (SARS-COV-2) (Coronavirus disease [COVID-19]), amplified probe technique.  

              Effective date March 15, 2020.

86328 – Immunoassay for infectious agent antibody(ies), qualitative or semiqualitative, single step

              method (e.g., reagent strip); severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2)   

              (Coronavirus disease [COVID-19]).                  

              Effective date April 10, 2020.

86769 – Antibody; severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus disease

              [COVID-19]). 

              Effective date April 10, 2020.               

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

SFY2020 4th quarter PFP payment will be made on May 20, 2020.

Thank you for your continued service to SoonerCare members.

Telehealth services expanded during the COVID-19 national and state emergency are being extended through June 30. OHCA will assess the status of the COVID-19 pandemic toward the end of June to determine if the expansion should be extended.

• OHCA will not require the pediatric behavioral health screen for each telemed well visit for children ages five and older. The screening requirement is annual unless something with the child has changed.
    
• OHCA will continue to pay for immunization administration when delivered outside of a well-child visit. The vaccine code must be on the claim.
    
• OHCA will not require an in-person follow-up well-child visit after a telemed visit. The provider will decide when they need to see the child again.
• Providers do not need new consent for telemed well-visits if a patient has already signed a consent form to be treated at that clinic. During the COVID-19 emergency declaration, OHCA considers a telemedicine visit to be the same as an in-person visit. The provider and family are allowed to determine if the telemedicine visit is the right service to provide.
• OHCA’s open telehealth codes will remain open until the emergency declaration has expired. We understand this helps to decrease no-shows and improves access to care in rural locations, so continuation of telehealth after the emergency will be evaluated.

• U0001 – CDC 2019 Novel Coronavirus (2019-NCOV) real-time RT-PCR Diagnostic Panel (This code to be used for CDC developed tests).
    
• U0002 – 2019-NCOV Coronavirus, SARS-COV-2/2019-NCOV (COVID-19), any technique, multiple types or subtypes (includes all targets), Non-CDC (This code to be used for non CDC developed tests, i.e. private labs).
    
• U0003 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
    
• U0004 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
    

• Laboratories are only eligible to bill for U0003 and U0004 if they run COVID-19 testing via high throughput technology that uses a platform that employs automated processing for more than two hundred specimens a day. Examples of high throughput technology as of April 14, 2020 include but are not limited to technologies marketed on that date as the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System GeneXpert Infinity System and NeuMoDx 288 Molecular.

OHCA will be monitoring laboratories billing services for U0003 and U004 and may request information on testing equipment and systems as warranted. 

We are unable to reimburse testing billed with new AMA CPT 87635 because CMS has not set pricing guidelines.  If this changes, we will send an update. Providers who have already billed claims for 87635 may rebill their claim using one of the above U-codes. 

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

Provider types/specialties: All

Telehealth services that have been expanded during the COVID-19 national and state emergency  are being extended through May 31.  OHCA will assess the status of the COVID-19 pandemic toward the end of May to determine if the expansion should be extended.

If you have any questions, please contact provider enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org.

Provider Types/Specialties: All

These sessions will be held via Zoom and you can find the links for each webinar at https://www.okhca.org/covid19#webinars. Click on the link for your provider type to register, then you will receive a confirmation email containing information about joining the webinar.

OHCA has reviewed the possibility of opening codes for teledentistry and has concluded that current CDT dental codes do not allow for virtual encounters in the absence of real time diagnostic procedures. Many of you will continue to see patients for emergency care during this time. You will continue to receive reimbursement for procedural codes performed for patients seen in real time.

Effective immediately and only as long as the national emergency surrounding COVID- 19 exists, OHCA will allow certain PT and OT services to be rendered via telehealth when appropriate. These services include the following CPT codes: 97110 (therapeutic exercise), 97530 (therapeutic activities), and 97535 (home management training for ADLs). These will need to be submitted with the GT modifier. These services will continue to require prior authorization. PT and OT evaluation and re-evaluation services are not appropriate for telehealth and will not be allowed.

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national and state emergency so all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020.

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national/state emergency so that all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national/state emergency so that all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020.

If you have any questions, please call the OHCA Provider Helpline at 800-522-0114. Thank you for your support of SoonerCare.

Effective March 1, 2020, providers may request a prior authorization for utilization of the D4346 code - scaling in the presence of generalized moderate or severe gingival inflammation. This code may be utilized for the removal of plaque and heavy calculus in the presence of swollen or inflamed gingiva, generalized suprabony pockets and moderate to severe bleeding on probing. It is indicated for patients with heavy calculus and deep probing pocket depths, in the absence of periodontitis (bone loss). When submitting for preauthorization, please include photographs along with radiographs and periodontal charting. Please consult the ADA CDT Dental Procedure Codes manual for more information on this code.

The American Academy of Pediatrics (AAP) recommends integrating postpartum depression screening and assessment at the one, two, four, and six month well-child (Early and Periodic Screening, Diagnostic and Treatment) visits. SoonerCare providers are encouraged to administer this important screening at these recommended visits. SoonerCare allows reimbursement of maternal depression screening when provided in accordance with the AAP Bright Futures periodicity recommendations. CPT code 96161 is currently reimbursed at $5.00. AAP recommendations for surveillance, screening tools, follow-up and more can be accessed at https://pediatrics.aappublications.org/content/143/1/e20183259. 

This class will supply providers with a high level overview of the OHCA pharmacy program. The presentation will have an emphasis on prescription drug abuse in the state, morphine milligram equivalent and medication assisted treatment changes. In addition, the prior authorization process, drug rebate program and other pharmacy initiatives will be discussed.

Register here to attend the SoonerCare Updates & Changes webinar: Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.