Global Messages

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

Effective immediately, professional claims with place of service 22 (outpatient) will no longer require referrals from the primary care physician. 

Provider Types/Specialties: 17/ 176-178

During this webinar from 2-3:30 p.m., Thursday, March 30, 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.

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

Effective for dates of service beginning March 1, 2023, OHCA will begin reimbursing for an evaluation and management service in addition to an Early Periodic Screening, Diagnosis and Treatment (EPSDT) screening for children ages 0-20 when appropriate. The EPSDT screening is still considered a comprehensive examination. However, if a member is receiving an EPSDT screening and an additional focused complaint arises that requires additional evaluation and management to address the complaint, the provider may deliver all medically necessary care and submit a claim for both the EPSDT screening and the appropriate level of focused service if the following requirements are met:

• The medical issue is significant enough to require additional work to address the issue.
• The visit is documented on a separate note.
• There is appropriate documentation that clearly lists the condition being managed at the time of the encounter and supports the billing of both services.
• Modifier 25 is added to the appropriate code that indicates that a separate evaluation and management service was provided by the same physician on the same day as the EPSDT screening. All claims submitted with Modifier 25 will be reviewed prior to payment.
• The following items will be reviewed prior to any payment:
  • Medical necessity.
  • Appropriate utilization of Modifier 25.
  • Appropriate level of service billed.
  • All documentation to support both the EPSDT screening and the additional evaluation and management for a focused complaint must be submitted for review.

When providing evaluation and management of a focused complaint during an EPSDT screening, the provider may claim only the additional time that is required above and beyond the completion of the comprehensive EPSDT screening.

An insignificant or trivial problem that is encountered in the process of performing the preventive evaluation and management service and does not require additional work is included in the EPSDT visit and should not be billed/reported.

Additional information regarding EPSDT visits can be found in OHCA Policy PART 4. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program/Child Health Services (oklahoma.gov).

PV Type:  03/30, 35

SFY 2023 Third Quarter PFP payment will be made on Feb. 22, 2023.

We thank you for your continued service to SoonerCare members.

PV Types:    01, 08, 31, 52

The year-end C-section rate letters for state fiscal year 2022 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.

Provider Types/Specialties: All

During this webinar from 2-3:30 p.m., Thursday, Feb. 16, providers will familiarize themselves with an overview of OHCA’s Third Party Liability and HMS process.

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.

Target Audience: Eye Care Providers

Each year, Oklahoma Health Care Authority performs a random sample audit of SoonerCare claims. This year’s review showed a higher-than-normal error based on the eye care provider maintaining records that document the SoonerCare member having received, picked up, being fitted, or being delivered frames, lenses, etc. 

As a reminder, please have the member or representative sign for the eyewear and maintain medical records for a minimum of six years per OAC 317:30-3-15. Record retention.

Providers: 27/270-279, 08/080-081 & 086

The Oklahoma Healthcare Authority has recently undergone a fee adjustment that was set with the effective date of Oct. 1, 2022. Claims filed from that date forward undergo claims recycle that is in progress. Per policy, providers are required to indicate their usual and customary charge when submitting claims. Providers who bill the SoonerCare allowable fee are advised to void and refile their claims from date of service Oct. 1, 2022 forward with their fees per policy. Please see Usual and Customary fee policy found at 317:30-3-5.1. Usual and Customary fees (oklahoma.gov)

Providers: Hospital (01), Clinic (08), Advance Practice Nurse (09), Mid-Level Practitioner (10), Laboratory (28), Physician (31), State Employed Physicians (52)

In May 2022, OHCA made updates in the MMIS claim system to change modifier 90 (reference [outside] laboratory) from an informational modifier to a denial modifier. OHCA has now set modifier 90 back to be an informational-only modifier, effective May 12, 2022.  Providers who received denials for claims lines where modifier 90 was applied may now refile those claims, if appropriate. Timely filing rules will apply. 

Providers: All

OHCA has updated coverage for laboratory testing of infectious diseases using molecular testing (CPT 87471-87801) effective Jan. 1, 2023. Providers will find the updated coverage guidelines on the Medical Authorization Unit’s webpage.

Changes include reopening coverage for CPT code 87634 (RSV) and 87637 (COVID-19, Flu A&B, and RSV) when performed by hospital labs, independent labs or clinic labs for symptomatic individuals who are immunocompromised, have chronic respiratory illness or influenza complicated by pneumonia, or who are pregnant.  

Target Audience: Licensed Oklahoma Providers and Organizations

OHCA will present a webinar titled Improving Care Coordination, Delivery, and Quality Utilizing Oklahoma’s Health Information Exchange at 12 p.m., Thursday, January 26. This webinar will provide the details of recent legislation regarding participation in Oklahoma’s state-designated Health Information Exchange (HIE), review the capabilities and benefits of utilizing the HIE to provide care and services, and discuss the process for joining and getting connected to the HIE.

Presenters:
Stephen W. Miller, CHCIO (State Coordinator for Health Information Exchange)
David C. Kendrick, MD, MPH (CEO, MyHealth Access Network)

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.