Global Messages
2022 Global Messages
| Date Posted | Title | Message |
| 12/19/22 | Increase in Dental Rates | Provider Types/Specialties: 27/270-279, 08/080-081 & 086 The Oklahoma Health Care Authority has updated the rate methodology used to pay for dental services as the agency was appropriated dollars within the state fiscal year 2023 budget to increase dental rates. Updating the dental rate methodology will improve the agency’s ratio of Medicaid reimbursement to private dental insurance reimbursement to 73.02% which is over a 10% improvement in this ratio. The increase in the aggregate for children is over 5%, and for adults over 14%. Rate increases will affect selective procedure codes, and which will appear in the revised fee schedule. The rate increase will not apply to orthodontic procedures. Some fees may be reduced by $0.01-0.02 due to rounding changes. |
| 12/13/22 | AuthentiCare EVV Training for Home Health | Provider Types/Specialties: 050,051, 145, 163, 170-175, 179, 228, 361, 363, 381 If you would like to participate in any of the upcoming EVV trainings, please sign up through the link below. Training Dates and Times: Friday, Dec. 9, 2022: Monday, Dec. 12, 2022: Tuesday, Dec. 13, 2022: Wednesday, Dec. 14, 2022: Thursday, Dec. 15, 2022: Friday, Dec. 16, 2022: Pre-Register: Choose one or more sessions by using the dropdown arrow (V) to find training dates and times. Registration URL: Link Expired Webinar ID: 783-749-019 If you have any additional questions regarding EVV, please send an email to the EVV team at EVV@okhca.org. |
| 12/13/22 | DocSign eSignature for provider contracts | Provider Types/Specialties: All Effective Dec. 15, 2022, OHCA will begin using DocuSign’s secure digital signature technology for SoonerCare provider contracting. Providers will be prompted to use DocuSign to electronically sign new and renewal provider applications. After signing the provider contract, OHCA via DocuSign will send you an email with the completed eSignature page attached. You may also download and/or print a copy of the DocuSign eSignature page for recordkeeping from the Forms and Agreements page of your application, or the “I want to” box on the Approved Provider landing page within the Provider Portal. |
| 12/7/22 | Coverage ended for COVID monoclonal antibody treatment Bebtelovimab | Providers: All Effective Dec. 5, 2022, OHCA has closed coverage for COVID monoclonal antibody treatment Bebtelovimab, reported by codes Q0222 and M0222. The FDA has removed the emergency use authorization (EUA) for this treatment as it is no longer expected to be effective against the dominating strains of COVID circulating at this time. Q0222 - INJECTION, BEBTELOVIMAB, 175 MG M0222 - INTRAVENOUS INJECTION, BEBTELOVIMAB, INCLUDES INJECTION AND POST ADMINISTRATION MONITORING |
| 12/1/22 | Donor Breast Milk Coverage | Effective 11/14/2022: OHCA began covering donor breast milk using code T2101 and requiring a Prior Authorization. DME providers may submit their request thru the Provider Portal utilizing the Medical radio button. Providers must submit Form HCA68, along with supporting documentation that medically justifies the need for the use of donor breast milk. Please review the full guideline located at Durable Medical Equipment (oklahoma.gov) |
| 11/30/22 | Behavioral Health/ABA Services Webinar | Provider Types/Specialties: 17/ 176-178 During this webinar, providers will familiarize themselves with an overview of ABA medical necessity criteria and prior authorization. Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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. |
| 11/30/22 | Nursing Facility Pay for Performance (PFP) Payment Update | PV Type: 03/30, 35 SFY2023 2nd Quarter PFP payment will be made on Nov. 30, 2022 Thank you for your continued service to SoonerCare members. |
| 11/30/22 | Public Health Emergency Extension | U.S. Secretary of Health and Human Services Xavier Becerra has extended the Public Health Emergency’s continuous coverage created in 2020 for certain Medicaid members. The extension is effective through April 30, 2023. It allows certain Oklahomans on Medicaid, who have become ineligible, to maintain their health coverage. OHCA is currently asking all members to update their contact information and contacting those members at risk of being ineligible due to missing information. If you speak to a member with questions about the PHE or their SoonerCare status, please encourage them to do the following:
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| 11/4/22 | Provider Rate Increase | Provider Types/Specialties: 05 (050), 16 (163), 21 (228), 36, 39, 46 Effective Oct. 1, 2022, there are now uniform rates for most service codes across the 1915c Home and Community-Based Waiver programs, along with State Plan Personal Care services and the Living Choice program. A complete list of services and rates for the Living Choice program and the Medically Fragile Waiver can be found by visiting Long Term Care Waiver Operations Division - Forms, Publications And Manuals (oklahoma.gov). If you have any additional questions, please contact us at oklahoma.livingchoice@okhca.org or medicallyfragilewaiver@okhca.org. |
| 10/24/22 | Public Health Emergency Extension | U.S. Secretary of Health and Human Services Xavier Becerra has extended the Public Health Emergency’s continuous coverage created in 2020 for certain Medicaid members. The extension is effective October 13, 2022. It allows certain Oklahomans on Medicaid, who have become ineligible, to maintain their health coverage over the next 90 days. OHCA is currently asking all members to update their contact information and is contacting those members at risk of being ineligible due to missing information. If you speak to a member with questions about the PHE or their SoonerCare status, please encourage them to do the following:
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| 10/18/22 | OHCA School-Based IEP Services Webinar | Provider/Specialty Types: 12/120, 126 Recommended audience: schools and any providers that render school-based services pursuant to an Individual Education Program. 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. |
| 10/10/22 | Allowance of Complete Dentures Five to Seven Years after Approval of Immediate Dentures | Provider Types/Specialties: 27/270-279, 08/080-081 & 086 According to OHCA policy regarding removable prosthetics, including both full and partial dentures, members are allowed one (1) appliance per arch every five (5) years for adults under twenty-five (25) years of age; and one (1) per arch every seven (7) years for adults twenty-five (25) years of age and over. Immediate dentures are allowed one (1) per arch per lifetime. A complete denture will not be allowed within (5) or seven (7) years, depending on the age of the member, of receiving any other full or partial denture appliance, including an immediate denture. |
| 10/4/22 | Patient Dismissal Process | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 OHCA has updated our Patient Dismissal Process. It includes new dismissal guidelines for inactive members, which are members that have not been seen by the provider in at least 24 months. The updated process can be found on our PCMH webpage under the PCP Tools and Resources section. Dismissal requests continue to be electronic and done on the secure provider portal. |
| 9/30/22 | Long-Term Care Cost Reports SFY22 | PV Type: 03/30, 31, 32, 33, 34, 35 Long-term care provider cost reports for SFY22 are due by Oct. 31, 2022. Facilities may be subject to a rate reduction, equal to the amount of the direct care portion of the daily rate, ranging from $20.35 to $54.94 per patient day, if cost reports are not received in a timely manner. We thank you for your attention to this matter. |
| 9/30/22 | Injection of biodegradable material next to prostate, CPT Code 55874 | Provider Types: 010, 014, 329, 347 Effective September 1, 2022, OHCA added coverage for: CPT 55874 - Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed. Coverage is for members ages 21 and older, with TXIX or HAP who are receiving radiation therapy for prostate cancer. No prior authorization required. |
| 9/30/22 | Molecular Diagnostic Testing for Infectious Diseases | Provider Types: ALL OHCA is updating coverage for laboratory testing of infectious diseases using molecular testing (CPT codes 87471-87801) effective November 1, 2022. Providers may find the updated coverage guidelines on the Medical Authorization Unit’s webpage at the following link: Molecular Diagnostic Testing for Infectious Diseases GL.pdf (oklahoma.gov). Please note that prior authorization will not be required for testing at this time. If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114. |
| 9/29/22 | Hospice services for Expansion Adults in long term care facilities | Provider Types: 03/ 30, 31, 34, 35 Effective October 1, 2022, Expansion Adults residing in long-term care (LTC) facilities, including nursing facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), may receive hospice services. NF and ICF/IID room and board per diem rates are reimbursed to the in-home hospice provider at a rate equal to 95% of the facility’s per diem rate. Hospice providers are responsible for passing the room and board payment through to the NF or ICF/IID. If Medicare is the primary payer of hospice benefits, OHCA will only reimburse the hospice provider for coinsurance and deductible amounts and will continue to pay the room and board to the nursing facility. For additional information, please contact the LTC Financial Management Unit at 405-522-7306. |
| 9/20/22 | Delivery Reform Town Halls | Provider Types: All The Oklahoma Health Care Authority invites you to attend one or both of our upcoming virtual town hall meetings on Sept. 29 and Oct. 5. These sessions will answer questions relating to the agency’s new delivery model, SoonerSelect. The focus will be on the needs of medical providers. Visit the Delivery Reform Town Halls page for details and to register. |
| 9/16/22 | Dental Code D4910 | Provider Types/Specialties: 27/270-279, 08/080-081 & 086 Effective September 12, 2022, CDT code D4910 is a covered SoonerCare benefit for both children and adults. Please refer to the Dental Fee Schedule for more information: https://oklahoma.gov/ohca/providers/claim-tools/fee-schedule.html#D. |
| 9/16/22 | Limited OB U/S in Emergency Room | Provider specialty: 010, 014, 315, 328, 341 Effective September 12, 2022, OHCA will no longer require a prior authorization for medically necessary, limited OB ultrasounds utilizing CPT code 76815 when performed in the emergency room. |
| 9/12/22 |
SoonerCare Eligibility Through NODOS or eNB-1 Webinar | Provider Types/Specialties: 01; 63/633, 634, 635; 11/138 The Oklahoma Health Care Authority will present SoonerCare Eligibility through NODOS or e-NB-1 webinar at 2 p.m. on Sep. 15. This webinar will educate facilities on the SoonerCare Notification of Date of Service (NODOS) and electronic newborn application (eNB-1) processes with instructions for online submission through the secure provider portal and helpful tips to optimize process utilization. Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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. |
| 9/12/22 | Patient-Centered Medical Home (PCMH) Obesity Performance Measure | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 OHCA will present a webinar titled PCMH Obesity Performance Measure on Thursday, October 13 at 2 p.m. This webinar will review obesity screening and reporting requirements for SoonerCare Choice PCMH providers. This presentation provides information on reporting requirements for the obesity performance measure and provide a brief overview of scorecards for PCMH providers. Target audience: SoonerCare Choice Patient-Centered Medical Home providers. OHCA welcomes your feedback and suggestions. 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. |
| 8/29/22 | Nursing Facility Pay for Performance (PFP) Payment Update | PV Type: 03/30, 35 The SFY2023 1st Quarter PFP payment will be made on Aug. 31, 2022. For your convenience, we have provided a link to the PFP Payment Summary worksheet, along with contact information, should you have questions regarding the program or payment details. PFP program questions contact: Jennifer Wynn – Jennifer.Wynn@okhca.org PFP payment calculation questions contact: Kim Potter – Kim.Potter@okhca.org We thank you for your continued service to SoonerCare members. |
| 8/26/22 | Qualifying Clinical Trials CMS Attestation Form | Provider Type- All As discussed in the Qualifying Clinical Trials global message from 06/10/2022, when requesting a prior authorization (PA) for a surrounding service associated with a qualifying clinical trial, please add a Q1 modifier to the service code. The Q1 modifier clarifies the service code being requested is a “routine clinical service provided in a clinical research study that is in an approved clinical research study.” Additionally, CMS has now provided a required clinical trial attestation form that must be completed and attached to the PA request, along with the medical documentation. If the QCT service will take place greater than 50 miles from the Oklahoma border, OHCA must issue an out of state service location authorization. Pursuant to section 1905 (a)(30) of the Social Security Act, a determination will be expedited and completed within 72 hours and will be made without regard to the geographic location or network affiliation of the health care provider treating the member or the principal investigator of the qualifying clinical trial. If the service is out of state, please fax the Medicaid Attestation Form and the HCA-65 (23782.pdf (oklahoma.gov) to Population Care Management at 405-530-3217. Medicaid Attestation Form link –https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/forms/medicaid-attest-form.docx |
| 8/25/22 | Delivery Reform Town Hall | Provider Types: All The Oklahoma Health Care Authority invites you to attend a hybrid town hall meeting on Aug. 31 at OKC MetroTech to answer questions relating to the agency’s new delivery model, SoonerSelect. The focus will be on the needs of medical providers. Visit the Delivery Reform Town Halls page for details and to register. |
| 8/24/22 | Pricing for Q0222 – COVID-19 Monoclonal Antibody Bebtelovimab | Providers: All OHCA has now added pricing for the COVID-19 monoclonal antibody Bebtelovimab (HCPCS code Q0222 – injection, Bebtelovimab, 175 mg) effective 8/15/2022. Providers should only bill for this product when purchased commercially and not when supplied free of charge by the Federal or State government. A copy of the purchase invoice must be kept in the member’s records. If the product is received from the government, the provider should only bill for the administration of the product and not include the product on the claim. If a provider receives payment for a government provided product, this would be considered an overpayment. The claim should be voided and then rebilled for the administration only. |
| 8/24/22 | Changes Impacting July 2022 SoonerExcel payments | Provider Types/Specialties: 08/082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 An error has been identified for SoonerExcel payments made on July 20, 2022, resulting in some Patient-Centered Medical Home (PCMH) providers receiving incorrect Improver Bonus payments for the Behavioral Health Screening, Obesity Screening and Emergency Department incentives. OHCA will adjust payments made to the affected Providers. Providers who received less than they qualified will be paid the difference on a future payment cycle. Providers who received more than they qualified will have an accounts receivable setup to recoup the overpayment from future payment cycles. Refer to provider letter 2022-19 for additional information. |
| 8/23/22 | Hepatitis C Treatment | Provider Types 09, 10, 31, 090, 092, 093, 100, 316, 318, 322, 344, 345, 349, 352, 355, 358, 541 The Oklahoma Health Care Authority (OHCA), to eliminate Hepatitis C in the SoonerCare population and lessen the burden for our providers, has entered into a Value-Based Agreement with AbbVie, the manufacturer of Mavyret®. Mavyret® no longer requires a prior authorization (PA) for SoonerCare members diagnosed with Chronic Hepatitis C. OHCA removed ALL PA documents required for this specific direct acting antiviral (DAA) Hepatitis C treatment. Members diagnosed with Chronic Hepatitis C may be prescribed Mavyret® without the need to see a specialist. Other DAA treatments for Chronic Hepatitis C will continue to have the same PA requirements which can be found at www.oklahoma.gov/ohca/pa in the “Hepatic Disorders” therapeutic category. |
| 8/11/22 | Modifier 25 and 59 Medical Review Bypass Code Lists for Professional Claims | OHCA has provided a list of procedure codes that do not require documentation review when billed with modifier 59/XE/XP/XS/XU to indicate a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day. Likewise, OHCA has also provided a list of E/M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes to indicate a significant separately identifiable service was performed on the same day. Both these lists and other information regarding NCCI edits can be found on the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html. |
| 8/5/22 | SoonerQuit Webinar | Provider Types/Specialties: 08, 09, 10, 16, 27, 31, 52 The Oklahoma Health Care Authority will present SoonerQuit webinar at 2 p.m. on Aug. 25. During this webinar, providers will familiarize themselves with components of the SoonerQuit Program’s Tobacco Free Environment Initiative. Topics to be explored are tobacco-free worksite policy development, 5A’s, nicotine replacement therapies, Oklahoma Tobacco Helpline referral setup, billing and coding, and additional nutrition efforts. This webinar is available for all SoonerCare providers interested in developing or updating their existing Tobacco Free policy, as well as those provider types that that can perform and bill for tobacco cessation services.
Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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. |
| 7/26/22 | Vaccines for Children (VFC) Webinar | Provider Types/Specialties: All The Oklahoma Health Care Authority will present a webinar titled Vaccines for Children (VFC) at 2 p.m., Thursday, Aug. 11. This webinar will review the Vaccines for Children (VFC) program. The VFC program is a federally funded program that provides vaccines at no cost to health care providers to administer to eligible children. Discussion of the requirements, incentives for joining the VFC program, storage and handling of vaccines, ordering, and the way costs and fees are handled will be covered. Target Audience: Oklahoma Medicaid providers interested in or currently administering vaccines through the VFC program. 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. |
| 7/21/22 | Public Health Emergency Extension | U.S. Secretary of Health and Human Services Xavier Becerra has extended the Public Health Emergency’s continuous coverage created in 2020 for certain Medicaid members. The extension is effective July 15, 2022. It allows certain Oklahomans on Medicaid, who have become ineligible, to maintain their health coverage over the next 90 days. OHCA is currently asking all members to update their contact information and contacting those members at risk of being ineligible due to missing information. If you speak to a member with questions about the PHE or their SoonerCare status, please encourage them to do the following:
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| 7/21/22 | Fluoride Varnish Quality Improvement Project | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100, 564; 09/090, 093 The Oklahoma Health Care Authority is looking for Patient Centered Medical Home primary care and pediatric clinics to participate in a project with the Quality Improvement department. In an effort to increase the use of Fluoride Varnish (FV) in the primary care setting, OHCA would like to share best practice workflows obtained through research by asking for participating clinics to record their FV application rate for a month and gather the data for the continued improvement process. If your clinic is interested in participating in this project, please email us at Quality@okhca.org. |
| 7/21/22 | Patient-Centered Medical Home (PCMH) Behavioral Health Screening and Performance Improvement Project (PIP) Reporting | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 The Oklahoma Health Care Authority will present a webinar titled PCMH Behavioral Health Screening and Performance Improvement Project Reporting at 2 p.m. on Tuesday, Aug. 16. This webinar will review Behavioral Health screening requirements for SoonerCare Choice PCMH providers and provides information about approved Behavioral Health screening tools, coding guidance, best practices while offering behavioral health resources for PMCH providers. A brief update on PIP reporting requirements will be provided. Target Audience: SoonerCare Choice Patient-Centered Medical Home providers. This presentation is not intended for contracted Behavioral Health providers. Please note the Behavioral Health screening content in a repeat from the May PCMH webinar. The PIP content is new. OHCA welcomes your feedback and suggestions. 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. |
| 7/13/22 | Delivery Reform Town Hall | Provider Types/Specialties: All The Oklahoma Health Care Authority invites you to attend a hybrid town hall meeting on July 19 in Tulsa to answer questions relating to the agency’s new delivery model, SoonerSelect. The focus will be on the needs of dental providers. Meetings focused on the needs of medical providers will be held at a future date. Visit the Delivery Reform Town Halls page for details and to register. |
| 7/12/22 | Dental Benefits for Members in Long Term Care Facilities | Provider Types/Specialties: 030, 031, 034, 035 On July 1, 2021, SoonerCare limited dental benefits became available for adults as referenced in Oklahoma Administrative Code 317:30-5-696. These benefits provide basic, medically necessary dental treatment. Some services may require prior approval from the rendering dental provider. Covered adult dental benefits can be viewed on the OHCA dental fee schedule. Dentures and related services are covered by and reimbursed through the nursing facility per diem rate. The services must be provided by the nursing facility at no cost/copay to the member. Please reference provider letter 2022-10 Re: Dental Benefits in Long Term Care Facilities. |
| 7/12/22 | Long Term Care (LTC) Cost Report | 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, 2022, will be due on or before October 31, 2022. You must report costs electronically via the OHCA Provider Portal, unless you are submitting a partial year cost report. All partial year cost reports must be submitted using the Data Entry File for Partial Year Reporting, which can be found on our website. 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 in the Provider Portal. Thank you for the services you provide to SoonerCare members. |
| 7/8/22 | Coverage of Insertion/Removal of Permanent Leadless Pacemaker, CPT Codes 33274/33275 | Provider Types/Specialties: 010, 014, 312, 313, 341, 342 Effective July 1, 2022, OHCA is adding coverage for:
Coverage for both codes is for ages 18 and older. Prior authorization is required for this service. |
| 7/6/22 | Out of State Claims | Provider Types/Specialties: All (except 24, 25, 27, & 28) According to policy OAC: 317:30-3-90, out-of-state services require prior authorization to assess whether out-of-state care is medically necessary. There are limited exemptions from these PA requirements, including instances in which emergency care is urgently needed and instances in which the health care provider is located within 50 miles of the Oklahoma border for medical care. Beginning July 1, 2022, the agency will be conducting prepayment claim reviews for services rendered outside of the State of Oklahoma. The goal is to ensure that SoonerCare members receive high-quality care from outstanding health care providers whether in-state or out-of-state in those limited circumstances where the health care needs of the member cannot be met in Oklahoma. To submit authorization for out-of-state services, please reference the details located at https://oklahoma.gov/ohca/individuals/policies-and-rules/oos-members/out-of-state-services-changes.html. If you have any questions, please call the OHCA Provider Helpline at 800-522-0114. |
| 6/30/22 | Hospice Services for Expansion Adults in Long Term Care Facilities | Effective Oct. 1, 2022, Expansion Adults residing in long-term care (LTC) facilities, including nursing facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), may receive hospice services. NF and ICF/IID room and board per diem rates are reimbursed to the in-home hospice provider at a rate equal to 95% of the facility’s per diem rate. Hospice providers are responsible for passing the room and board payment through to the NF or ICF/IID. If Medicare is the primary payer of hospice benefits, OHCA will only reimburse the hospice provider for coinsurance and deductible amounts and will continue to pay the room and board to the nursing facility. For additional information, please contact the LTC Financial Management Unit at 405-522-7306. |
| 6/22/22 | Patient-Centered Medical Home (PCMH) Redesign Obesity Performance Measure and New Provider Scorecards | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 OHCA will present a webinar titled Patient-Centered Medical Home (PCMH) Redesign Obesity Performance Measure and New Provider Scorecards on Thursday, July 21 at 2 p.m. This webinar will provide an overview of the SoonerCare Choice Obesity Performance Measure and Provider Scorecards. Attendees will learn about the requirements of the Obesity performance measure, new provider scorecards, and an upcoming opportunity to participate in voluntary mock audits. 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. |
| 6/13/22 | Physical Therapy and Occupational Therapy Use of SC Modifier Clarification | Provider Types/Specialties: 08/087, 17/170-171, 174-175 The use of the SC modifier is appropriate when submitting a physical therapy or occupational therapy prior authorization request for initial post-operative surgeries and acute injuries. Please note the current therapy modifiers are still required – GP for physical therapy and GO for occupational therapy. The Oklahoma Health Care Authority defines post-operative surgeries and acute injuries as follows
Inappropriate use of the SC modifier will result in a cancellation of the prior authorization request. All cancelled prior authorization requests must be resubmitted as a new request. Please remember OHCA does not allow submission of retro requests for therapy. |
| 6/10/22 | Qualifying Clinical Trials | Provider Types/Specialties: All Effective immediately, when requesting a prior authorization (PA) for a surrounding service associated with a qualifying clinical trial, please add a Q1 modifier to the service code. The Q1 modifier clarifies that the service code being requested is a “routine clinical service provided in an approved clinical research study.” |
| 6/10/22 | Chiropractor Resources | Provider Types/Specialties: 08/187, 15/150 In an effort to reduce the number of opioid prescriptions for back pain, OHCA implemented alternative treatments for pain management effective Jan. 1, 2022, consisting of coverage for chiropractic care for adults ages 21 years and older. A Guide for SoonerCare Chiropractors has been published to the provider training page to help chiropractors become familiar with coverage, contracting requirements, verifying SoonerCare member eligibility and prior authorization for services. Additionally, a chiropractors and SoonerCare webinar recording is available to view with the respective Q&A document on the provider training page under the Previous Webinars section of the page. For any questions, please call the OHCA provider helpline at 800-522-0114 or email SoonerCareEducation@okhca.org. |
| 5/31/22 | RE: PCMH Mock Audits for Compliance Reviews | Provider Types/Specialties: 08/082, 088; 09/093; 10/100; 31/316, 318, 322, 344, 345, 568 The Quality Assurance (QA) department at the Oklahoma Health Care Authority will be conducting mock audits for medical record compliance review as a part of ongoing efforts to innovate the SoonerCare Choice Patient-Centered Medical Home (PCMH) program. You can register online for the mock audits starting Aug. 1, 2022, through Nov. 10, 2022. Participation is voluntary. Please reference Provider Letter 2022-06 for more information about signing up for the mock audits. |
5/26/22 |
Long Term Care PFP Payment Update | Provider Types/Specialties: 03/030, 035 SFY2022 4th Quarter PFP payments will be made on May 25, 2022. We thank you for your continued service to SoonerCare members. |
| 5/19/22 | Dental Prior Authorization and Amendments Webinar | Provider Types/Specialties: 27/270-279, 08/080, 081, 086 OHCA will present a webinar titled “Dental Prior Authorization and Amendments” on Tuesday, June 7 at 2 p.m. This webinar will provide a current look at covered dental services requiring a prior authorization, the documents required for each submission and how to submit a prior authorization and amendment on the SoonerCare provider portal. Target Audience: dentists, orthodontists and administrative 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. NOTE: To streamline the amendment process, the Dental Authorization Unit is implementing a change in the orthodontic banding and prior authorization amendment requests. Effective immediately, providers can submit their amendment requests, including orthodontic bandings, through the secure provider portal. This will be the only acceptable way to submit such request starting June 10, 2022. |
| 5/18/22 | Electroencephalogram (EEG) in Inpatient Facility | Provider Types/Specialties: 010, 014, 326 and 523 Providers are reminded there is no prior authorization required for physician interpretation and report services for long term EEG monitoring when performed while a member is inpatient. Affected codes are: 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725 and 95726. |
| 5/17/22 | LTC Cost Report & QOC Submission Training Webinar | Provider Types/Specialties: Extended Care Facility (03)/(030) Nursing Facility, (031) ICF/IID > 6 beds, (034) ICF/IID < 6 beds & (035) Skilled Nursing Facility OHCA will present a webinar titled "LTC Cost Report & QOC Submission Training” on Thursday, June 9 at 10 a.m. This webinar will provide detailed instructions on how to submit both the Quality of Care Monthly Report, and the Annual LTC Cost Report. Target Audience: All Medicaid Long-Term Care Facilities 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. |
| 5/16/22 | Laboratory Billing Reminders | Provider Types: Hospital (01), Clinic (08), Advance Practice Nurse (09), Mid-Level Practitioner (10), Laboratory (28), Physician (31), State Employed Physicians (52) Per OHCA policy, laboratory services must be billed by the laboratory that performs the testing. It is not appropriate for a provider to bill for lab testing they refer to another laboratory to perform. See OAC 317:30-5-20 Laboratory Services for more information. Modifier 91 is only to be used to report a subsequent medically necessary laboratory test on the same day of the same previous laboratory test. More information on the appropriate use of Modifier 91 can be found at the following link. |
| 5/11/22 | Contracts Expiring June 30, 2022 | Provider Types: 24, 25 The following contracts expire June 30, 2022: Pharmacy, DME and medical supplies. To avoid any delay in reimbursement, OHCA encourages providers to begin the renewal process as soon as possible. Visit the provider training page 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. The 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 contracts will include language recommending a tobacco-free environment. Implementing a tobacco-free environment is beneficial to employees, patients, and visitors as it supports the creation of a safe and healthy workplace, helps protect against second and third hand smoke exposure, and encourages people to quit. In addition, generating awareness of this change through signage, decals and other means of communication is highly encouraged. If you need assistance with developing or updating a tobacco-free environment policy or obtaining signage, the SoonerQuit program can assist you with your specific needs. Please email the SoonerQuit team at SoonerQuit@okhca.org for more information. |
| 5/2/22 | C-Section Rate Letters |
Provider Types: 01, 08, 31, 52 C-section rate letters for the first half of state fiscal year 2022 are now available through the OHCA Provider Portal. If you need help retrieving your letters, please call 800-522-0114. You may also view the SoonerCare C-section rates and reports available at www.okhca.org/c-section. Thank you. |
| 4/27/22 | High Risk OB Prior Authorization Changes | Provider Types/Specialties: 31, 52/328, 335, 568 To streamline the high-risk OB PA process and to cut down on the need for an amendment to change units from one code to another, procedure group codes have been created. Effective immediately, you can submit your PA request using the appropriate group code listed below (modifiers not required) and you will continue to file your claims using the appropriate CPT code and modifiers.
Also, as a part of this change, we have implemented some automation steps to the review process to assist with quicker turnaround times. Please note the automation piece of this change will only take place on prior authorization requests submitted with an individual provider number. Requests submitted with a group number will not process through any of the automation steps. |
| 4/25/22 | Ending Coverage for G0396 and G0397 | Provider Types: 08, 09, 10, 11, 31, 52, 53 Effective May 1, 2022, OHCA will no longer cover codes G0396 and G0397 when used for screening alcohol and substance use with brief intervention. OHCA will continue to cover CPT 99408 for this important service. |
| 4/22/22 | COVID-19 Booster Vaccine | Effective March 29, 2022, OHCA opened coverage for the following COVID-19 booster dose-specific vaccine and administration when used in accordance with the emergency use authorization (EUA) from the FDA:
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| 4/20/22 | Medical Prior Authorizations Webinar |
The Oklahoma Health Care Authority is presenting a webinar for SoonerCare providers on Thursday, May 26 to provide instruction on the prior authorization process for medical services. It will include member and procedure verification steps and a demonstration of a prior authorization submission using the secure provider portal. Note: This webinar does not contain information on using InterQual review and is not recommended for behavioral health, dental or waiver providers. Target Audience: SoonerCare providers and staff who submit authorization requests for medical services. Visit the OHCA Provider Training page to register for the Medical Prior Authorizations webinar on Thursday, May 26 from 2 p.m. to 3:30 p.m. 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. |
| 4/20/22 | Public Health Emergency Extension | The Secretary of Health and Human Services announced the COVID-19 public health emergency (PHE) has been extended for 90 days, effective April 16, 2022. The extension allows certain Oklahomans on Medicaid who have become ineligible to maintain their health coverage over the next 90 days. We are currently asking all members to update their contact information, as well as reaching out to those members at risk of being ineligible due to missing information. If you speak to a member with questions about the PHE or their SoonerCare status, please encourage them to do the following:
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| 4/14/22 | Patient Centered Medical Home (PCMH) Behavioral Health Screening and Mock Audit Opportunity | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 This webinar will review behavioral health screening requirements for SoonerCare Choice patient-centered medical home providers. This presentation provides information about approved behavioral health screening tools, coding guidance, best practices, and offers behavioral health resources for PCMH providers. A brief update on the PCMH redesign, including information on the opportunity to register and participate in a PCMH mock audit, will be provided. Target Audience: SoonerCare Choice patient-centered medical home providers. This presentation is not intended for contracted behavioral health providers. 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. |
| 4/14/22 | Changes with Electronic Remittances Advice (ERA) | Provider Types: All This is to inform you of changes that will take place within the Electronic Remittances Advice (ERA). After the implementation of ClaimXTen, providers noticed changes to the way their claims were processed versus information submitted on the claim. For example: a provider submitted an incorrect procedure code based on age/gender of a member. Instead of the claim denying for incorrect procedure code, ClaimXTen will deny the line and zero out the billed amount for that code but will add another claim line with a more appropriate procedure code and the previous billed amount. Currently, the ERAs do not show the zero-dollar amount on the original denied detail line but, going forward, the HIPAA remark codes for ClaimXTen EOB’s will display a zero-dollar amount, regardless of the amount billed. |
| 4/12/22 | Reminder for SoonerCare Provider Town Hall | Reminder for SoonerCare Provider Town Hall Provider Types/Specialties: 01, 08/080-082, 086, 184, 193, 199, 208; 09; 10; 05; 03; 11; 23-25; 27; 31; 53 The Oklahoma Health Care Authority is hosting a town hall for all SoonerCare providers to gain feedback on the Comprehensive Quality Strategy (CQS). The CQS aims to make health care services better for your patients and community. Discussion topics will include:
The town hall will be held virtually on Thursday, April 14 from 8 a.m. – 4 p.m. |
| 4/8/22 | Prior Authorization Amendment Changes | Provider Types/Specialties: All (except 11 & 27) To streamline the amendment process, the Medical Authorization Unit is implementing a change in the submittal of amendment requests. Effective immediately, providers can now submit their amendment requests through the secure provider portal. Please see Prior Authorization Amendment Process for step-by-step instructions. The faxed option will be discontinued and faxes for PA amendments will no longer be accepted effective May 1, 2022. |
| 3/30/22 | Chiropractors and SoonerCare Webinar | Provider Types/Specialties: 15, 08/187 The Oklahoma Health Care Authority is presenting a webinar for chiropractors on Thursday, April 21 that will provide information about the SoonerCare provider contract process and includes helpful resources for providing Oklahoma Medicaid services. Target Audience: Chiropractors providing alternative treatments for pain management to SoonerCare adults. Visit the OHCA Provider Training page to register to attend the Chiropractors and SoonerCare webinar on Thursday, April 21 from 2 p.m. to 3:30 p.m. 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. |
| 3/29/22 | Contracts Expiring March 31, 2022 | Provider Types/Specialties: 26/260, 23/230, 20/200, 17/170, 17/171, 17/173, 14/140 The following contracts expire March 31, 2022: ambulance services, dietician, audiologist, occupation/physical/speech therapist and podiatrist. To avoid any delay in reimbursement, OHCA encourages providers to begin the renewal process as soon as possible. Visit the provider training page 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. The 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. |
| 3/29/22 | Percutaneous Transcatheter Closure of the Left Atrial Appendage with Endocardial Implant CPT 33340 | Provider Types/Specialties: 011, 014, 312, 313, 341, 342 Effective March 1, 2022, OHCA is adding coverage for CPT 33340 - Percutaneous Transcatheter Closure of the Left Atrial Appendage with Endocardial Implant for ages 18 and older. Prior authorization is required for this service. |
| 3/25/22 | Survey of Oklahoma Sickle Cell Health Care Providers | Provider Types/Specialties: All Dear health care provider to Oklahomans living with sickle cell disease: In 2021, the Oklahoma State Department of Health (OSDH) awarded funding to Supporters of Families with Sickle Cell Disease, Inc. to measure the current status of sickle cell care in Oklahoma. This survey is being conducted to understand the challenges health care professionals face in Oklahoma when caring for individuals and their families who live with the lifelong challenges of effectively managing sickle cell disease (SCD). OSDH has established a diverse committee to review the findings of the SCD needs assessment and explore solutions to address gaps in knowledge about SCD best practices related to medical treatment and community-based wraparound support services. Supporters of Families with Sickle Cell Disease is a nonprofit organization that is working to address the complex health, psychosocial and economic needs of individuals and families impacted by SCD by providing culturally sensitive health education, care coordination and community-based support services. Results of this survey will be reported in summary form without revealing any personal identification information of the respondents. All individual survey data will be kept strictly confidential and will not be shared with anyone or any organization. Please complete this SCD needs assessment survey no later than April 15, 2022. It should take less than five minutes to complete. If you have any questions about completing the survey, please call 918-619-6174 for assistance. Survey link: https://corexms4rwq6fk59vz3v.qualtrics.com/jfe/form/SV_agADw6BKVyBrbmK. Thank you for your time and professional input. |
| 3/25/22 | New Codes to Report Underimmunization for COVID-19 Status | Providers: All Effective April 1, 2022, CMS has developed two new diagnosis codes to report underimmunization for COVID-19 status
When providers are reporting CPT 99401 to report COVID-19 vaccine counseling for children ages 0-20, they should now also bill with either of these new applicable diagnosis codes. More information on COVID-19 vaccines can be found on the CDC website at the following link: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/ |
| 3/21/22 | Claim Processing Updates for Outpatient Facilities | The Oklahoma Health Care Authority is presenting a webinar for providers on Thursday, April 28 and Thursday, May 5 that will cover the integration of ClaimsXten™ software into the MMIS claims processing system for Outpatient Facility claims in support of the National Correct Coding Initiative (NCCI). Target Audience: SoonerCare providers and staff that bill outpatient claims on a UB-04 claim type. Visit the OHCA Provider Training page to register to attend the Claim Processing Updates for Outpatient Facilities webinar on Thursday, April 28, 2022 from 2 p.m. to 3:30 p.m. or on Thursday, May 5, 2022 from 2 p.m. to 3:30 p.m. 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. |
| 3/17/22 | SoonerCare Provider Town Hall |
The Oklahoma Health Care Authority is hosting a town hall for all SoonerCare providers to gain feedback on the Comprehensive Quality Strategy (CQS). The CQS aims to make health care services better for your patients and community. Discussion topics will include:
The town hall will be held virtually on Thursday, April 14 from 8 a.m. – 4 p.m. |
| 3/17/22 | Additional Dental Codes for Adults | Provider Types/Specialties: 27/270-279, 08/080-081 & 086 Effective July 1, 2021, the following five codes have been added to the Adult Limited Dental Benefit: D0210, D7310, D7471, D7472, and D7473. Please refer to the Dental Fee Schedule for more information. Medical necessity must always be documented in the members’ records and timely filing applies. Please contact DentalServices@okhca.org with any questions. |
| 3/10/22 | Changes to Provider Action Form for PCMH (SC-13) | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 Effective March 10, 2022, OHCA will no longer accept the SC-13 Provider Action Form from primary care providers (PCPs) to override age restrictions on a PCP panel. SC-13 forms are for PCPs to enroll a member to their panel and override their current capacity. Please make sure you review your panel size and age restriction prior to this change.
Reasons for submitting an action form include: • Adding an immediate family member of an established patient when the panel is at capacity. • Adding an established patient when the panel is at capacity.
PCP change requests for all other reasons must be initiated online at www.mysoonercare.org or by calling the SoonerCare helpline at 800-987-7767.
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| 3/9/22 | Introduction to SoonerCare Webinar | Provider Types/Specialties: All The Oklahoma Health Care Authority is presenting a webinar for providers that will give a high-level overview of Oklahoma Medicaid, known as SoonerCare. This webinar will review SoonerCare eligibility requirements, programs, benefits available to members, and information about getting started as a SoonerCare provider. Target Audience: Providers and staff who are new to SoonerCare. Visit the OHCA Provider Training page to register to attend the Introduction to SoonerCare webinar on Thursday, April 14, 2022, from 2 p.m. to 3:30 p.m. 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. |
| 3/1/22 | Digital Breast Tomosynthesis CPT 77063 HCPCS G0279 | Provider Types/Specialties: 01, 08, 09, 10, 16, 29, 31, 52 Effective March 1, 2022, OHCA is adding coverage for Digital Breast Tomosynthesis (3D mammogram) for ages 10 and older. The appropriate codes to use when billing for this service are as follows:
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| 3/1/22 | Provider Letter 2022-03 RE: SoonerCare Choice Program Changes | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 As a part of ongoing efforts to innovate the SoonerCare Choice Patient-Centered Medical Home (PCMH) program, Oklahoma Health Care Authority will be implementing multiple changes throughout the 2022 calendar year related to medical home agreement requirements, QA SoonerCare Choice compliance reviews and tier requirements. Please reference Provider Letter 2022-03 for more information about the changes. |
| 3/1/22 | SoonerCare Provider Contracts Webinar |
Provider Types/Specialties: All OHCA will present a webinar titled SoonerCare Provider Contracts on Wednesday, Mar. 2, 2022, at 2 p.m. This webinar is a comprehensive overview of OHCA’s SoonerCare provider enrollment process with information on new contracts and contract renewals, and helpful tips for efficiency and accuracy. Target Audience: all Oklahoma Medicaid providers and 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. |
| 3/1/22 | COVID-19 Vaccine Counseling |
Provider Types: All Effective 4/1/2021, OHCA will reimburse for COVID-19 vaccine counseling to and for the benefit of SoonerCare members ages 0-20 using CPT 99401 – preventive medicine counseling, typically 15 minutes. The claim line for 99401 must include the ICD-10 diagnosis code Z71.89 (other specified counseling) and the CR modifier. The service will not be separately reimbursable when performed the same day as a COVID-19 vaccine administration as those codes already include counseling. A counseling visit is a conversation between a provider and a patient, parent or guardian about the COVID-19 vaccine. Conversations may include topics such as patient’s reasons for not being vaccinated, addressing concerns identified by the patient, providing tailored and individualized medical advice regarding COVID-19 vaccine for that patient, and providing resources about how to get a COVID-19 vaccine if applicable. Counseling visits should be documented in a patient’s medical record according to standard documentation guidelines. It would not be appropriate to bill for this additional service just for checking vaccination status. |
| 3/1/22 | COVID-19 Diagnoses | Provider Types: 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):
For any questions regarding COVID-19-related copay or billing issues, please call the OHCA provider helpline at 800-522-0114. |
| 2/24/22 | Nursing Facility Pay for Performance (PFP) Payment Update | Provider Types/Specialties: 03/30, 35 SFY2022 3rd Quarter PFP payment will be made on Feb. 23, 2022. We thank you for your continued service to SoonerCare members. |
| 2/17/22 | COVID-19 Test Kit Reimbursement |
OHCA is now reimbursing pharmacies for over the counter COVID-19 test kits. Reimbursement will be paid to contracted pharmacies that dispense the test kits to a SoonerCare member. COVID-19 test kits do not count against a member’s monthly prescription limit and there is no copayment. |
| 2/11/22 | Dental Prior Authorization Requests Cancelled for Missing Documentation | Provider Types/Specialties: 27/270-279, 08/080-081 & 086 Due to the high volume of dental prior authorization requests, any request not containing all necessary documentation will be cancelled. This change is effective immediately. |
| 2/9/22 | 2022 Patient Centered Medical Home (PCMH) Redesign Webinar | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 OHCA will present a webinar titled 2022 Patient Centered Medical Home (PCMH) Redesign on Tuesday, March 8 at 2 p.m. and Thursday, March 24 at 2 p.m. This webinar will provide an overview of the SoonerCare Choice compliance review and tier requirement changes effective Jan. 1, 2023. Attendees will learn more about the opportunity to participate in mock audits, provider engagement process changes and SoonerCare Choice website updates. 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. |
| 2/9/22 | Appropriate Use of Modifier 91 for Laboratory Billing |
Provider Types/Specialties: 28 OHCA would like to remind laboratory providers of the proper use of modifier 91, repeat clinical diagnostic laboratory testing. Modifier 91 is used to report repeat laboratory tests or studies performed on the same day on the same patient. This modifier is added only when additional test results are to be obtained subsequent to the initial administration or performance of the test(s) on the same day. It is not used when laboratory tests or studies are simply rerun because of specimen or equipment error or malfunction. Nor is it to be used when a test is repeated to confirm initial test results. Furthermore, based on the definition of modifier 91, it should not be reported when the basic procedure code(s) indicate that a series of tests are to be obtained. More information on the appropriate use of modifier 91 can be found at the following link: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144503#:~:text=Print-,Modifier%2091,Lab%20services%20examples%3A,-Line%201%20%3D%2084132 |
| 2/1/22 | Referral Required Claim Edit | Claims for Expansion Adults enrolled in the SoonerCare Choice program that denied for no PCP referral for dates of service prior to Jan. 1, 2022, may be resubmitted for consideration of payment.
A referral guide is available on the OHCA provider training page at https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/2021/Referral%20Guide.pdf |
| 1/28/22 | Over the Counter Covid Test Kits | Provider Types/Specialties: All OHCA is now reimbursing pharmacies for over the counter COVID-19 test kits. Reimbursement will be paid to contracted pharmacies that dispense the test kits to a SoonerCare member. COVID-19 test kits do not count against a member’s monthly prescription limit and there is no copayment. For more information, please visit https://oklahoma.gov/ohca/providers/types/pharmacy/pharmacy-updates.html. |
| 1/28/22 | Provider Letter 2022-01 Re: Vaccination Requirements | Provider Types: All Provider Letter 2022-01 was sent on Jan. 25, 2022. It describes the CMS rule regarding COVID-19 vaccination requirements for Medicare/Medicaid certified facilities and enforcement of the rule by the Oklahoma State Department of Health. View Provider Letter 2022-01 here. |
| 1/26/22 | Care Management Provider Survey |
Provider Types: All OHCA is encouraging providers to complete a brief questionnaire so we may assess and increase provider awareness of care coordination services available to members with higher levels of social and health care needs. Please follow this link to participate in the Care Management Provider Survey. Thank you for your participation and passion to serve SoonerCare members. |
| 1/25/22 | Public Health Emergency Extension | The US Dept. of Health and Human Services has extended the public health emergency (PHE) declaration for 90 days. It is now scheduled to end April 16, 2022. The PHE renewal is posted here. What does this mean for SoonerCare providers and members?
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| 1/20/22 | SoonerCare Provider Contracts Webinar | Provider Types/Specialties: All OHCA will present a webinar titled SoonerCare Provider Contracts on Tuesday, Feb. 22, 2022, at 2 p.m. This webinar is a comprehensive overview of OHCA’s SoonerCare provider enrollment process with information on new contracts and contract renewals, and helpful tips for efficiency and accuracy. Target Audience: all Oklahoma Medicaid providers and 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. |
| 1/19/22 | Eligibility in regard to Prior Authorizations | Provider Types/Specialties: 08/081, 082, 086; 27/270-279 This message serves as a reminder that providers are responsible for checking member eligibility. Prior authorization end dates are generally set at six months from date of authorization. If a member should lose eligibility before that date, and a claim is made for a service after loss of eligibility, the claim will not pay. Please be diligent in checking eligibility before providing services. |
| 1/19/22 | COVID-19 Treatments |
Providers: All OHCA covers the following COVID-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA:
OHCA also covers Evusheld (tixagevimab co-packaged with cilgavimab) for the pre-exposure prophylaxis of COVID-19 for adults and pediatric members 12 years of age and older (weighing at least 40kg) with no known COVID-19 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s). |
| 1/19/22 | Acute Hospital Care at Home | Provider Types: 01 As a reminder, inpatient facilities can apply through CMS for the ability to provide some inpatient services to patients in their home. Each facility must apply individually. Additional information can be found at https://qualitynet.cms.gov/acute-hospital-care-at-home. |
| 1/14/22 | Long-Acting Reversible Contraceptives in an FQHC | Provider Types/Specialties: 08/080 Effective Dec. 30, 2021, OHCA will allow reimbursement for long-acting reversible contraceptives (LARC) in addition to the FQHC encounter rate. The compensation for the LARC will be at the current fee-for-service rate. Please view Provider Reimbursement Notice 2022-01 for more information. |
| 1/11/22 | Modifier 25 and 59 Medical Review Bypass Code Lists | OHCA has provided a list of procedure codes that do not require documentation review when billed with modifier 59 to indicate a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day. Likewise, OHCA has also provided a list of E/M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes to indicate a significant separately identifiable service was performed on the same day. Both these lists and other information regarding NCCI edits can be found on the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html. |
| 1/10/22 | C-Section Rate Letters |
Provider Types: 1, 8, 31, 52 The year-end C-section rate letters for state fiscal year 2021 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. You may also view the C-section rate release schedule on the OHCA webpage at www.okhca.org/c-section. Thank you. |
| 1/7/22 | Member Demographic Change Process | Provider Types/Specialties: All Beginning February 1, 2022, OHCA will no longer accept Member ID Correction forms. Providers should contact the SoonerCare Helpline at 800-987-7767 to report any member demographic changes. Agency Partners should contact the number above and then select option 4 and enter their PIN to access the Agency Partner Helpline. |
| 1/7/22 | PT/OT/ST Developmental Testing | Provider Specialties: 087, 170, 171, 173, 182 Effective Feb. 1, 2022, OHCA will no longer separately reimburse for developmental testing performed by physical therapists, occupational therapists or speech therapists utilizing CPT codes 96112 and 96113. Codes used to bill therapy evaluation services already include reimbursement for any testing that may be required to develop a therapy treatment plan. CPT 96112 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour CPT 96113 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes |
| 1/7/22 | Soon-to-be-Sooners Limited Dental Benefits | Provider Types/Specialties: 08/081, 086; 27/271, 272, 274, 275 Effective Jan. 1, 2022, Soon-to-be-Sooner members (STBS/STBS-M) are eligible for limited dental benefits, which are necessary for the health and well-being of the unborn child during pregnancy and birth. Providers will be compensated for providing the following dental codes when medically necessary.
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| 1/3/2022 | SoonerCare Choice Referrals Webinar | Provider Types/Specialties: All OHCA will present a webinar titled SoonerCare Choice Referrals on Thursday, Feb. 10, 2022, at 2 p.m. and Thursday, Feb. 24, 2022, at 2: p.m. This class will discuss the SoonerCare Choice referral guidelines for members enrolled with a patient-centered medical home provider and provide instructions on administrative referral requirements. Note: Referrals submitted through the OHCA secure provider portal by I/T/U providers to specialists will not be covered. Target Audience: SoonerCare Choice primary care providers and medical homes who issue referrals and specialists who receive referrals. 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.
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