Global Messages

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

OHCA wants to remind primary care providers that SoonerCare’s patient dismissal process is fully electronic through the OHCA secure provider portal. Additionally, SoonerCare Choice providers can access a patient dismissal process guide on the OHCA provider training page under Resources or directly by visiting this link: https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/resources/Patient%20Dismissal%20Process.pdf

Provider Types: 08, 09, 10, 31, 52

Effective July 21, 2021, OHCA expanded coverage of preventive medicine visit CPT codes 99385-99387 and 99395-99397 to cover all adult members including those in Title XIX and the Expansion Healthy Adult Program (HAP). Providers who previously provided these services and were denied payment for these codes may void their previous claim and refile a new claim for possible reimbursement. As a reminder, when these claims are refiled, they will be processed through the new ClaimsXten editing software and claims may process differently than when they were first billed.  

For any questions, please call the OHCA provider helpline at 800-522-0114.

99385 – Initial new patient preventive medicine evaluation, 18-39 years old

99386 – Initial new patient preventive medicine evaluation, 40-64 years old

99387 – Initial new patient preventive medicine evaluation, 65 years and older

99395 – Established patient preventive medicine evaluation, 18-39 years old

99396 – Established patient preventive medicine evaluation, 40-64 years old

99397 – Established patient preventive medicine evaluation, 65 years and older

Provider Types/Specialties:  31/ 316, 318, 322, 344, 345, 568; 09/ 093; 10/ 100; 08/ 080, 081, 082, 088, 184, 185

Reminder for medical home primary care providers, the SoonerExcel payment methodology and incentives are changing January 1, 2022. Provider Letter 2021-13 provides an overview of the changes. 

The November PCMH redesign webinars and related Q/A are available to view on the Provider Training webpage. OHCA will offer future trainings featuring additional information on PCMH redesign throughout 2022. To sign up for upcoming trainings, please visit the Provider Training webpage. 

OHCA continues to welcome your feedback and suggestions on the upcoming changes. Please send comments and questions to medhomecomments@okhca.org. 

We are excited to advance the PCMH program together with you.

Provider Types: 01, 08, 09, 10, 15, 17, 31, 52

In an effort to reduce the number of opioid prescriptions for back pain, OHCA is implementing alternative treatments for pain management effective January 1, 2022. This program consists of coverage for chiropractic care and physical therapy (PT) in a non-hospital-based setting for adults, effective as follows:

For chiropractor services, OHCA will cover CPT codes 98940, 98941, and 98942 for adults ages 21 years and older. These visits will be limited to a total of 12 visits per calendar year when provided for a diagnosis of spinal pain and will require a prior authorization (PA). Chiropractors will also be allowed to bill for an evaluation or re-evaluation using CPT codes 99202, 99203, 99212, or 99213, for a combined total of two evaluation and management (E&M) visits per calendar year – these two E&M visits will not require a PA.

For physical therapy services, OHCA will extend coverage of CPT codes 97161, 97162, 97163, 97164, 97110, and 97530 for adults aged 21 years and older in a non-hospital-based setting when provided for a diagnosis of spinal pain. PT eval and re-eval services will each be allowed once per year and will not require a PA. Therapy service codes 97110 and 97530 will be allowed for a combination of 48 units per calendar year combined (1 unit=15 minutes) and will require a PA. 

There is no change to coverage of PT services for adults provided in an outpatient hospital facility.  Members can still receive up to 15 visits per year per each discipline for physical, occupational and speech therapy. These services are allowed for all medically necessary indications, as well as spinal pain. 

For any questions, please call the OHCA provider helpline at 800-522-0114.

98940 – Chiropractic manipulative treatment, 1-2 spinal regions

98941 – Chiropractic manipulative treatment, 3-4 spinal regions

98942 – Chiropractic manipulative treatment, 5 spinal regions

99202 – New patient, level 2 office visit

99203 – New patient, level 3 office visit

99212 – Established patient, level 2 office visit

99213 – Established patient, level 3 office visit

97161 – PT eval, low complexity, 20 minutes

97162 – PT eval moderate complexity, 30 minutes

97163 – PT eval high complexity, 45 minutes

97164 – PT re-eval established plan of care

97110 – Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes

97530 – Therapy procedure using functional activities

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 

OHCA will be presenting a webinar titled 2022 Patient Centered Medical Home (PCMH) Redesign on Thursday, Jan. 13, 2022, at 2 p.m. and on Thursday, Jan. 27, 2022, at 2 p.m. This webinar will provide an overview of the SoonerCare Choice program and redesign goals for 2022. Attendees will learn more about the SoonerExcel incentive changes, reimbursement structure and new provider scorecards. Information on best practices and CMS resources will also be reviewed.

Target Audience: Current and prospective patient-centered medical home providers and staff.

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org

Visit the OHCA Provider Training page to register.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

During the PHE (public health emergency) period, some SoonerCare members have received extended eligibility. To avoid eligibility from expiring once the PHE period ends, OHCA requests providers relay an important message to certain members. When verifying eligibility, if there is a red notice displayed on the eligibility screen, it is imperative that members contact us to confirm continued eligibility. Please have the member contact the SoonerCare helpline at 800-987-7767.

SoonerCare is also encouraging providers to help remind members they can log in to their account at www.mysoonercare.org to read related messages and update case information 24/7.

Thank you for your assistance and support of SoonerCare.

Provider Types/Specialties:  All

In an effort to assist the transition of expansion adults to SoonerCare Choice patient-centered medical homes and alignment with primary care, the “referral required” edit for claims was temporarily suspended. On Jan. 1, 2022, the edit will be reinstated, and referrals will be required for SoonerCare Choice expansion adults seeking specialty services.

A referral guide is available on the OHCA provider training page at https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/Referral%20Guide.pdf.

Provider Types: 08, 09, 52

The date to submit a contract renewal for groups, nurse practitioners, and state-employed physicians has been extended until Jan. 31, 2022. Providers are encouraged to submit the renewal as soon as possible to avoid any delay in reimbursement. For assistance with completing the contract renewal, please visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html to view the how-to video on renewing your SoonerCare contract. The video is located under the SoonerCare How-to Videos dropdown titled “Renewing Your SoonerCare Contract”.

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

Provider Types/Specialties:  03/30, 35

SFY2022 2nd Quarter PFP payment will be made on November 24, 2021.

We thank you for your continued service to SoonerCare members.

Provider Types/Specialties:  08, 09, 52

Contracts for Groups (08), Advanced Registered Nurse Practitioners (09), and OSU/OU Physicians (52) expire Nov. 30, 2021. To avoid any delay in reimbursement, OHCA encourages providers to begin the renewal process as soon as possible. Visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html for a how-to video on renewing your SoonerCare contract. The video is located under the SoonerCare How-To Videos dropdown titled “Renewing your SoonerCare contract”.

Additionally, providers unable to access the OHCA secure provider portal to submit a contract renewal must complete a PIN reset form. Global message dated March 19, 2021 provides instructions on how to complete the PIN reset form.

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

OHCA will be conducting a webinar titled “Dental Updates and Changes” on Tuesday, Dec. 14, 2021, from 2 p.m. to 3:30 p.m.

This class will provide information regarding the most recent changes and updates for dental providers.

Recommended Audience: All Dental Staff

Visit the OHCA Provider Training page to register.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

Provider Types/Specialties:  08/080, 081, 086; 27/270-279

Effective July 1, 2021, dental providers may bill for administration of COVID-19 vaccinations utilizing the following codes:

D1701 – Pfizer-BioNTech COVID-19 vaccine administration – first dose.
D1702 – Pfizer-BioNTech COVID-19 vaccine administration – second dose.
D1703 – Moderna COVID-19 vaccine administration – first dose.
D1704 – Moderna COVID-19 vaccine administration – second dose
D1707 – Janssen (Johnson & Johnson) COVID-19 vaccine administration.

Complete documentation is required that includes manufacturer, lot number, expiration date, name and license number of person administering the injection, site (on body) of administration, address of the provider, date of administration, and informed consent.

Please refer to the following links for guidelines:

https://www.cdc.gov/vaccines/covid-19/index.html

https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/coronavirus/covid-19-vaccine-information-and-resources/principles_for_legislation_on_dentists_as_vaccine_administrators.pdf?rev=90206b35df9841bab20fa00b48da260f&hash=4602DEA8CBA9412604D7D3E06ABEF9E9

Providers: All

Providers are reminded there are no copays when providing COVID-19-related services to SoonerCare members.

When providing a COVID-19-related service, providers should include one of the following diagnoses on their claim (when appropriate):

• U071 – 2019 Novel Coronavirus
• J1282 – Pneumonia Due to Coronavirus 2019
• M3581 – Multisystem Inflammatory Syndrome
• M3589 – Other Specified Systemic Involvement of Connective Tissue
• Z1152 – Encounter for Screening for COVID-19
• Z20822 – Contact with and Suspected Exposure to COVID-19
• Z23 – Encounter for Immunization Z8616 – Personal History of COVID-19

For any questions regarding COVID-19-related copay or billing issues, please call the OHCA provider helpline at 800-522-0114.

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

If you have a current group or individual provider agreement as a medical home primary care provider, this global message serves as the required contractual notification that OHCA is amending the SoonerExcel payment methodology.

Beginning Jan. 1, 2022, SoonerExcel incentives will target emergency department utilization, diabetic control, behavioral health screening and obesity. Provider Letter 2021-13 provides an overview of the changes, information about provider scorecards and resources available to assist patient-centered medical home (PCMH) providers with transitioning to the new set of SoonerExcel measures.    

OHCA will be conducting webinars on Thursday, Nov. 18 from 2 p.m. to 3:30 p.m. and Tuesday, Nov. 30 from 2 p.m. to 3:30 p.m. to provide an overview of the changes and available resources. Please visit the Provider Training webpage to register for one of the upcoming webinars.

OHCA continues to welcome your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org.

We are excited to advance the PCMH program together with you.

Provider Tpyes/Specialties: All

OHCA will be conducting a webinar titled “Claim Processing Updates: Claims Xten and NCCI Edits” on Thursday, Dec. 9, 2021, and Dec. 16, 2021, from 2 p.m. to 3:30 p.m.

This webinar will cover the integration of Claims Xten software into the MMIS claims processing system in support of the National Correct Coding Initiative (NCCI).

Note: Topics involving claim submissions, claim denials, or coding guidance will not be included.

Recommended audience: All Oklahoma Medicaid providers and staff who bill 1500 professional claims.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the

Provider Types/Specialties: All

The Centers for Medicare and Medicaid Services (CMS) has issued a press release on the emergency regulation requiring COVID-19 vaccinations for health care workers. The press release may be viewed here: https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care.

Provider Types/Specialties:  08, 09, 52

Contracts for Groups (08), Advanced Registered Nurse Practitioners (09), and OSU/OU Physicians (52) expire Nov. 30, 2021. To avoid any delay in reimbursement, OHCA encourages providers to begin the renewal process as soon as possible. Visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html for a how-to video on renewing your SoonerCare contract. The video is located under the SoonerCare How-To Videos dropdown titled “Renewing your SoonerCare contract”.

Additionally, providers unable to access the OHCA secure provider portal to submit a contract renewal must complete a PIN reset form. Global message dated March 19, 2021 provides instructions on how to complete the PIN reset form.

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

Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 

OHCA will be presenting a webinar titled 2022 Patient Centered Medical Home (PCMH) Redesign on Thursday, Nov. 18, 2021, at 2 p.m. and on Tuesday, Nov. 30, 2021, at 2 p.m.

This webinar will provide an overview of the SoonerCare Choice program and redesign goals for 2022. Attendees will learn more about the SoonerExcel incentive changes, reimbursement structure and new provider scorecards.

Target Audience: Current and prospective patient-centered medical home providers and staff.

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org

Register to attend the 2022 Patient Centered Medical Home (PCMH) Redesign webinar on Thursday, Nov. 18, 2021, from 2 – 3:30 p.m.:  https://okhca.zoom.us/webinar/register/WN_ZuUTMN6eRt-7c4btUpe_Ew.

Register to attend the 2022 Patient Centered Medical Home (PCMH) Redesign webinar on Tuesday, Nov. 30, 2021, from 2 – 3:30 p.m.: https://okhca.zoom.us/webinar/register/WN_xdArX3hgQNuRAE7_ievBPQ.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

Provider/Specialty Types: 12/120, 126
 
OHCA will be presenting a webinar titled OHCA School-Based IEP Services on Wednesday, Nov. 10, 2021 from 2 p.m. to 3:30 p.m.

This webinar is for SoonerCare contracted qualified school providers and their rendering practitioners who are billing SoonerCare for medically necessary services pursuant to an individual education plan (IEP).

The OHCA School-Based IEP Services training will cover the requirements for contracting and billing SoonerCare for school-based IEP health-related services.

Recommended Audience: Schools and any providers that render school-based services pursuant to an individual education program.

Register to attend the OHCA School Based Services webinar on Wednesday, Nov. 10 from 2 – 3:30 p.m.:  https://okhca.zoom.us/webinar/register/WN_t1cB5U0XQz6xxG9XZMWMwg.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

The 2022 SoonerCare Choice Redesign will enhance the Patient-Centered Medical Home SoonerExcel Pay for Performance incentives and payment structure.

SoonerExcel incentives and payments are being realigned to improve health outcomes and quality for all SoonerCare Choice members.

2022 SoonerExcel incentives target emergency department utilization, diabetic control, behavioral health screening and obesity. 

Be on the lookout for a provider letter and new SoonerExcel scorecards with baseline data detailing historical performance on emergency department utilization and behavioral health screening coming in November. Providers will have the opportunity to participate in informative webinars detailing the changes beginning in November and throughout 2022.

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org.

We are excited to advance the PCMH program with you. 

OHCA has provided a list of E&M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes.

For more information, visit the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html.

The US Dept. of Health and Human Services has extended the public health emergency through January 31, 2022. The public health emergency renewal is posted here.

What does this mean for SoonerCare providers and members?

• Expanded use of telehealth services 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/Specialties: 27/270-278, 08/080

Caries risk assessment is not required for any prior authorizations for the adult population. This was stated in error in the OHCA Adult Limited Dental Benefit Provider Guide. We apologize for this inconvenience.

Provider Types/Specialties: All

Global message 8/13/21 offers providers guidance regarding the override process for the monthly visit limit for members of the SoonerCare Adult Expansion program. Note: the four visit per month limit does not apply to Choice PCP visits. Members enrolled with a patient-centered medical home provider may receive unlimited visits with their assigned primary care provider.

Provider Types/Specialties:  27/271, 274, 275, 278; 08/080

This code should be utilized when there are four or more teeth in the quadrant meeting the criteria of alveolar bone loss and probing pocket depths, as specified in the OHCA Provider Guide https://oklahoma.gov/content/dam/ok/en/okhca/docs/individuals/programs/dental/Provider%20Guide%20Adult%20Limited%20Dental%20Benefit.pdf . Obvious subgingival calculus should be visible on the radiographic images, and bleeding on probing should be noted. The teeth involved should not have a poor prognosis or be scheduled for extractions. Please make sure interproximal bone is visible on images of all teeth with bone loss. If fewer than four teeth in the quadrant meet these criteria, the D4342 may be more applicable. Four quadrants of SRP will not be approved in conjunction with a recent D1110 oral prophylaxis. Please contact the OHCA dental unit at Dental.Services@okhca.org if you have any questions regarding PAs for any of the periodontal codes.

Provider Types/Specialties: 27/270-278, 08/080

OHCA has seen a huge increase in the number of PAs due to Medicaid expansion and the implementation of the Adult Limited Dental Benefit. This has caused an increase in turnaround time, which we are currently working to improve. We apologize for the inconvenience and appreciate your patience and willingness to continue to serve SoonerCare members.

Provider Types/Specialties: All

This class will give participants a better understanding of SoonerCare adult expansion with an overview of expansion eligibility requirements and benefits, a discussion on transition to the Choice program, and cost-sharing information.

Recommended audience:  All SoonerCare providers.

Register to attend the “Understanding the Basics of SoonerCare Expansion” webinar on Thursday, Oct. 21, 2021, from 2:00 – 3:30 p.m.:  Expired Link

Register to attend the “Understanding the Basics of SoonerCare Expansion” webinar on Thursday, Oct. 28, 2021, from 2:00 – 3:30 p.m.:  Expired Link

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

OHCA will be conducting a webinar titled “OHCA Public Website” on Thursday, Oct. 14, 2021, from 2 – 3:30 p.m.

The webinar will provide a live demonstration of navigating the OHCA public website (www.oklahoma.gov/OHCA) and contain provider-focused resources. Subjects will include locating forms, policy information, enrollment tools, training resources and more.

Note: Functions through the OHCA Secure Provider Portal will NOT be discussed.

Recommended audience: All Oklahoma Medicaid providers and staff.

Register to attend the “OHCA Public Website” webinar on Thursday, Oct. 14, 2021, from 2 – 3:30 p.m.:

https://okhca.zoom.us/webinar/register/WN_1lIqO8V5S0yvnJZSDqsxJw

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

Provider Types/Specialties:  All

The Oklahoma Health Care Authority is excited to announce upcoming changes to the SoonerCare Choice Patient-Centered Medical Home (PCMH) program beginning January 2022. A video announcing the upcoming changes has been posted to the Patient Centered Medical Home webpage. Please stay tuned as there will be future opportunities for provider engagement and training. We are excited to advance the PCMH program together with you.  
https://oklahoma.gov/ohca/providers/types/soonercare-choice/patient-centered-medical-home.html

Provider Types/Specialties: 03/030

Effective September 28, 2021, nursing facilities may request a copy of their PASRR summary of findings. Contact the Behavioral Health Unit with the Oklahoma Health Care Authority at 800-522-0114, select option 6 for prior authorization, and option 2 to reach inpatient behavioral health. Once you reach the Behavioral Health Unit, please let an analyst know you need a copy of your summary of findings and provide them with the email address it will be sent to.

Provider Types/Specialties:  03/30, 31, 32, 33, 34, 35

Long-term care provider cost reports for state fiscal year 2021 are due by Oct. 31, 2021.

Facilities may be subject to a rate reduction, equal to the amount of the direct care portion of the daily rate, ranging from $20.78 to $53.53 per patient day, if cost reports are not received in a timely manner.

We thank you for your attention to this matter.

Peripheral Nerve Stimulator Trial Codes Prior Authorization Change

Provider Types/Specialties: 01, 02, 08, 25, 31, 52

Effective November 1, 2021, the Oklahoma Health Care Authority (OHCA) will implement prior authorization (PA) requirements for the Peripheral Nerve Stimulator Trial Codes with CPT codes: 64555 and 64575.

For more information, visit: https://oklahoma.gov/ohca/providers/claim-tools/prior-authorization/medical.html

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

Effective October 1, 2021, expansion adult members will be able to enroll into the SoonerCare Choice program and choose a patient-centered medical home (PCMH)/primary care provider (PCP) or an Indian Health Service, Tribal Program, or Urban Indian Clinic (I/T/U) provider. OHCA will not require referring provider information on specialty provider claims until Dec. 1, 2021. Specialists currently providing services to these members during this period must verify if the member is assigned to a primary care provider and obtain a referral to avoid claim denials after Dec. 1, 2021. An FAQ document is available on the OHCA public website here https://oklahoma.gov/content/dam/ok/en/okhca/docs/about/expansion/HAP%20Choice%20FAQs.pdf.

Current PCMH and I/T/U program providers can increase panel limits and adjust age restrictions using the OHCA secure provider portal’s Update Provider Files feature. For assistance updating your panel on the provider portal, or to contract as a patient-centered medical home or I/T/U provider and render services to SoonerCare Choice members contact the OHCA Provider Helpline at 800-522-0114.  

Provider Types: 27, 270-279

Reminder: individual dental provider contracts expire in 10 days on September 30, 2021.

These contracts can be renewed now.

To avoid any delay in reimbursement, we encourage dental providers to submit their renewals as soon as possible. Visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html for a how-to video on Renewing your SoonerCare Contract. The video is towards the bottom of the page.

The new contracts will include language asking providers to employ tobacco cessation best practices in partnership with the SoonerQuit program. Please email SoonerQuit@okhca.org for more information.

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

Provider Specialty: ALL

Effective immediately, OHCA will only reimburse for one unit of vaccine administration code CPT 90471 per day.

When additional percutaneous, intradermal, subcutaneous or intramuscular vaccine immunizations are administered the same day, they should be billed using CPT 90472. This follows correct coding guidelines per the American Medical Association (AMA) CPT coding manual.

90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections); one vaccine (single or combination vaccine/toxoid)

90472 - Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)

For questions, please contact the OHCA provider helpline at 800-522-0114.

This class will cover the many updates and changes within the SoonerCare program. Some of these will include SoonerCare expansion, applied behavioral analysis (ABA) service revisions, member copayment refunds, bariatric surgery revisions and other topics.​

Recommended audience:  all Oklahoma Medicaid providers and staff.

Register to attend the “SoonerCare Updates and Changes” webinar on Thursday, Sept. 23, 2021, from 2:00 – 3:30 p.m.:  Expired Link

Register to attend the “SoonerCare Updates and Changes” webinar on Thursday, Sept. 30, 2021, from 2:00 – 3:30 p.m.:  https://okhca.zoom.us/webinar/register/WN_BS_AhKxaRSGSsSw0lLYiYA.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

Provider Types/Specialties: All

SoonerRide is a program that provides non-emergency transportation for SoonerCare members to medically necessary appointments. The Oklahoma Health Care Authority (OHCA) and ModivCare (formerly LogistiCare) will be presenting multiple webinars titled “SoonerRide Program Overview” during September 2021.

Attendees will learn more about the SoonerRide program, how to request a SoonerRide, types of trip reservations, mileage reimbursement, program limitations, and guidelines for SoonerRide approvals.

Recommended Audience: Oklahoma Medicaid providers and scheduling staff

*Register to attend the “SoonerRide Program Overview” webinar on Thursday, Sep. 9, 2021 from 1 – 2:30 p.m.: 
Expired Link

*Register to attend the “SoonerRide Program Overview” on Tuesday, Sep. 21, 2021 from 2 – 3:30 p.m.:

Expired Link

*After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.    

Provider Types/Specialties: All

OHCA will be presenting a webinar called “Introduction to SoonerCare – Part 3 (Coverage & Exclusions)” on Thursday, Aug. 26 from 2:00 to 3:30 p.m.

This class is part three of a series called “Introduction to SoonerCare” and will provide a general overview of Oklahoma Medicaid coverage and exclusions for adults and children. Coverage for waiver programs including Advantage and Home and Community Based Waiver Services will not be included. 

Recommended Audience: New Oklahoma Medicaid providers and staff.

Register at the link below to attend the “Introduction to SoonerCare – Part 3 (Coverage & Exclusions)” webinar on Thursday, Aug. 26 from 2:00 to 3:30 p.m.:

Expired Link

Provider Types/Specialties: All

OHCA will be presenting a webinar called “Introduction to SoonerCare – Part 2 (Benefits & Programs)” on Thursday, Aug. 19 from 9:00 to 10:30 a.m.

This class is part two of a series called “Introduction to SoonerCare.” Attendees will learn more about the various Oklahoma Medicaid member benefits and programs. Demonstrations will be provided on how these programs appear on the provider portal when conducting an eligibility search. It will provide an in-depth look at the eligibility process, qualifications and verification for Oklahoma Medicaid members. Claims and HMS third party liability discussions will not be included in this session.

Recommended Audience: New Oklahoma Medicaid providers and staff.

Register at the link below to attend the “Introduction to SoonerCare – Part 2 (Benefits & Programs)” webinar on Thursday, Thursday, Aug. 19 from 9:00 to 10:30 a.m.:

Expired Link

The US Dept. of Health and Human Services has extended the public health emergency for 90 days. The previous extension was set to expire on July 20, 2021. The public health emergency renewal is posted at: https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-19July2021.aspx

What does this mean for SoonerCare providers and members?

• Expanded use of telehealth services 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.
  

Please take 5-10 minutes to complete the Oklahoma Health IT Survey!

Provider Types: 08, 09, 10, 16, 27, 31, 52

Click this Link to Participate: https://mslc.qualtrics.com/jfe/form/SV_8dEgUcc3XHW5Dp4

The Oklahoma Health Care Authority has identified you and your organization as important stakeholders for the Health Information Technology (Health IT) Environmental Scan which will help inform an update to the Oklahoma State Medicaid Health IT Plan (SMHP). We request your participation in a survey to better understand the current health care technology landscape, illustrate Oklahoma’s progress of electronic health record (EHR) adoption since the inception of the Promoting Interoperability (PI) program to today, and identify areas of opportunity to ensure continued progress towards statewide and national interoperability.

Results from the survey will be used to inform the state’s health IT strategy and future direction, which will be described in the final SMHP. Your responses will remain anonymous.

This survey is designed to collect information about:

• Your current capabilities and plans related to EHR, health information exchange (HIE) and social determinants of health (SDOH).
• Your barriers and concerns regarding EHR, HIE and SDOH.
• Your experience with HIE organizations, such as Coordinated Care Health Network, MyHealth Access Network and OKSHINE.
• Your experience with the Promoting Interoperability Program (if applicable).

Please follow this link to participate in the Oklahoma Health IT Survey: OK eScan Survey

Please feel free to forward this email as necessary to ensure the correct individuals have access to the survey link.

Thank you in advance for your assistance in participating in this survey. Should you have any questions, please contact Myers and Stauffer at OKHealthIT@MSLC.com.       

Provider Types: All

OHCA has added more dates in July for provider training webinars titled SoonerCare Expansion: Healthy Adult Program.

These webinars will address the adult expansion population enrolled in the Healthy Adult Program, eligibility requirements, benefits and cost-sharing.

Recommended Audience: Contracted SoonerCare providers

Register to attend the SoonerCare Expansion: Healthy Adult Program webinar on:

Thursday, July 15, 2021 from 2 p.m. to 3:30 p.m.:  Expired Link.

Wednesday, July 21, 2021 from 2 p.m. to 3:30 p.m.:  Expired Link.

Thursday, July 22, 2021 from 2 p.m. to 3:30 p.m.:  Expired Link.

Tuesday, July 27, 2021 from 10:00 am – 11:30 a.m.:  Expired Link.

Provider Types/Specialties: 03/030

Effective July 22, 2021, the electronic PASRR Level 1 (LTC-300R) will now allow providers to edit demographics, diagnoses, the Level 1 PASRR screening section and the consultation section. Providers will also have the ability to print the LTC – 300R.

Training for this provider group will occur during the months of July and August of 2021.

Register to attend the ‘Electronic Submissions for PASRR Level 1(LTC-300R)’ webinar on Tuesday, July 20, 2021 from 10 a.m. to 11:30 a.m.:

Expired Link.

Register to attend the ‘Electronic Submissions for PASRR Level 1(LTC-300R)’ webinar on Wednesday, July 28, 2021 from 10 a.m. to 11:30 a.m.:

Expired Link.

Register to attend the ‘Electronic Submissions for PASRR Level 1(LTC-300R)’ webinar on Wednesday, August 4, 2021 from 2 p.m. to 3:30 p.m.:

Expired Link.

Provider Types: All

OHCA will be presenting two webinars in July titled “SoonerCare Expansion: Healthy Adult Program.”

These webinars will address the adult expansion population enrolled in the Healthy Adult Program, eligibility requirements, benefits and cost-sharing.

Recommended Audience: Contracted SoonerCare providers

Register to attend the “SoonerCare Expansion: Healthy Adult Program” webinar on Wednesday, July 14, 2021 from 2 p.m. to 3:30 p.m.:

Expired Link.

Register to attend the “SoonerCare Expansion: Healthy Adult Program” webinar on Thursday, July 15, 2021 from 2 p.m. to 3:30 p.m.:

Expired Link.

After registering, you will receive a confirmation e-mail containing information about joining the webinar.    

Provider Types: 27, 270-279

Dental contracts expire September 30, 2021 and can be renewed beginning July 15, 2021. To avoid any delay in reimbursement, we encourage dental providers to submit their renewals as soon as possible. Visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html for a how-to video on Renewing your SoonerCare Contract. The video is towards the bottom of the page. 

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

The new contracts will include language asking providers to employ tobacco cessation best practices in partnership with the SoonerQuit program. Please email SoonerQuit@okhca.org for more information. 

Provider Types:  All

Members who are a part of SoonerCare expansion will have an active eligibility line that reads Expansion Healthy Adult Program (HAP).  These members’ benefits will be Title XIX benefits; however, the Title XIX line will not show as active.

For more information on the comparison of benefits, please visit: https://oklahoma.gov/ohca/individuals/mysoonercare/soonercare-benefits.html.

Expansion adults will fall into the category “SoonerCare Traditional: Adults 21 and Over”. 

Provider Types: All

The Electronic Data Exchange Agreement (EDEA) with OHCA, Gainwell Technologies and Trading Partners, Billing Agents, Clearinghouses and Telecommunication Vendors(VANS) for Oklahoma Soonercare will be extended. The current EDEA expired on June 30, 2021, but OHCA has now extended the agreement to June 30, 2022. All current terms, conditions, transaction cost and requirements will remain the same during this period. If you have any questions or concerns, please contact our EDI department at 1-800-522-0114, option 2, 2.

OHCA and Gainwell will work together over this period to simplify and update the current document. We appreciate your services to our Providers and Members.

Provider Types: All

SoonerCare coverage for newly eligible expansion adults in the Healthy Adult Program begins July 1, 2021. The Healthy Adult Program is a fee-for-service payment model. Members will not be assigned a Patient Centered Medical Home (PCMH) and no SoonerCare referral is required at this time.

Services that currently require prior authorization will continue to require prior authorization for the Healthy Adult Program. Billing procedures for this population remains unchanged. Monthly cost sharing will apply for all non-exempt SoonerCare adult members. More information can be found at https://oklahoma.gov/ohca/about/medicaid-expansion/expansion.

For questions, please contact the OHCA Call Center at 1-800-522-0114, option 1.

Provider Types: 27/270-278, 08/080

OHCA will be presenting a webinar titled ‘Dental Changes & Updates’ on Thursday, July 8, 2021 from 2:00 p.m. to 3:30 p.m.

This class will provide information regarding the most recent changes and updates for Dental providers. The attendees will learn about contract renewal, PIN reset process, expanded dental benefits for adults, eligibility for the expansion population and changes for the prior authorization and claims processes.

Recommended Audience: All dental providers and staff

Register to attend the ‘Dental Changes & Updates’ webinar on Thursday, July 8, 2021 from 2:00 p.m. to 3:30 p.m.: 

Expired Link.

After registering, you will receive a confirmation e-mail containing information about joining the webinar.

OHCA will be presenting webinars titled "SoonerSelect Dental Basics" on Tuesday, May 11 from 2 p.m. to 3:30 p.m. and Thursday, May 13 from 10 a.m. to 11:30 a.m.

This class provides an overview of the upcoming Dental Benefit Plan (DBP) changes. Topics include transition of managed care, member populations affected by the transition, contracting with a DBP, requirements of the MCO/DBPs and responsibilities of OHCA.

Recommended Audience: All SoonerCare Dental providers

Register to attend the ‘SoonerSelect Dental Basics’ class on Tuesday, May 11:
Expired Link.

Register to attend the ‘SoonerSelect Dental Basics’ class on Thursday, May 13:
Expired Link.

The webinar registration requires manual approval. Once approved, you will receive a confirmation email containing information about joining the webinar.

The US Department of Health and Human Services has extended the public health emergency for 90 days.

The previous extension was set to expire on April 21, 2021.

The public health emergency renewal is posted at: https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx.

What does this mean for SoonerCare providers and members?

• Expanded use of telehealth services 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/Specialties:  All

The Oklahoma Health Care Authority and the Oklahoma Department of Mental Health and Substance Abuse Services are providing Unlocking Implicit Bias Training for medical professionals on April 26, 2021 from 2-3 p.m. and April 27, 2021 from 12 - 1p.m. The link to register can be found on the provider training page at https://oklahoma.gov/ohca/providers/provider-training.

Provider types: All

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)
• Q0245 – Injection, bamlanivimab and etesevimab, 2100 mg (Eli Lilly) (effective date 2/9/2021)
• M0245 – Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring (Eli Lilly) (effective date 2/9/2021)

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

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

91303 – Janssen (Johnson & Johnson) COVID-19 vaccine (effective date 2/28/2021)

• 0031A – Janssen (Johnson & Johnson) COVID-19 vaccine administration – single dose

OHCA is still awaiting approval from CMS for pharmacies to administer the vaccine and be reimbursed.

Provider Types/Specialties: 03/030

Effective March 1, 2021, the Oklahoma Healthcare Authority (OHCA) will only be accepting electronic submissions for PASRR Level I (LTC-300R) and Level II. It will be the responsibility of the nursing facility or provider to submit the Level I and Level II in a timely manner. Phone calls to OHCA Psych/ID analysts should be reserved for questions such as, but not limited to, 30 day exempted hospital discharges that are about to lapse and require a Level II PASRR, seven-day emergency PASRR requests, PASRR policy, questions about quarantine due to COVID-19 and Level I corrections.

Please contact the OHCA internet help desk at 800-522-0114, select option 1 for provider, enter your provider number, select option 2 for the internet helpdesk and then notify them that you have experienced a technical issue while submitting your PASRR Level I (LTC300R) electronic form. For questions concerning the PASRR Level II electronic submission form, please contact the behavioral health unit at 405-522-7597, select option 1 for provider, option 6 for prior authorizations and option 2 to reach inpatient behavioral health. The PASRR Level II electronic form is located at https://oklahoma.gov/ohca/providers/types/behavioral-health-and-substance-abuse-services/behavioral-health-and-substance-abuse-services.html, under templates/forms.

Please note: Your provider number was given to you upon contracting with OHCA. Please contact your business office to obtain a copy of this if you do not have it. After you select option 1 for provider, please be sure to listen to the recording completely as it will tell you how to enter the alphabetical letter at the end of your provider number.

Provider Types / Specialties: 270-275, 080

According to OHCA policy OAC 317:30-5-696(J)iii, prior authorization is required for members who have a treatment plan requiring more than two (2) anterior and/or any posterior root canals.  Two (2) or fewer anterior and/or posterior root canals within a twelve month period, will not require prior authorization. 

Numeric Provider Types:  01

Numeric Provider Specialties: 

Global Message Body: Hospital providers who wish to bill for services provided in a psychiatric or rehabilitation unit must do so using a separate provider number by completing an addendum to their hospital contract. The addendum to hospital contracts for psych and rehab units can now be accessed online at https://oklahoma.gov/ohca/providers/provider-enrollment.html.

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

The public health emergency renewal is posted at: https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-07Jan2021.aspx.

What does this mean for SoonerCare providers and members?

• Expanded use of telehealth services through April 30, 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.

PV Specialties: 087, 120, 126, 145, 170, 171, 173, 174, 175, 179, 182

Provider letter 2021-02 informs providers about the reimbursement for the coverage of services that are rendered by physical therapy, occupational therapy, speech-language pathology therapy assistants and speech-language pathology clinical fellows. Please post all comments by close of business Monday, Feb. 8, 2021, via the Oklahoma Health Care Authority policy change blog. Thank you.

PV Specialties: 634

Provider letter 2021-01 informs providers about coverage for adults in a psychiatric hospital. Please post all comments by close of business Monday, Feb. 8, 2021, via the Oklahoma Health Care Authority policy change blog. Thank you.