Global Messages

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

Panel size maximum limits were removed Nov. 4, 2022, for PCPs participating in the PCMH program. This enables PCMH PCPs to determine the maximum capacity of their panel size and empowers providers to make choices that best suit their practice.

As changes to panel size are available in real time and can be updated via the secure provider portal, this negates the need for the action form process. Providers wishing to add members to their panel when it is at full capacity will be responsible for updating their file panel size limit to accommodate those members.

Please note, the minimum capacity for panels did not change and remains at 50 patients (refer to Oklahoma Administrative Code 317:25-7-5).

If you need assistance or have questions about these changes, please contact SoonerCareEducation@okhca.org.

Provider types: 08, 09, 10, 13, 17, 31, and 52

OHCA has distributed the second round of Provider Incentive Program dollars to the contracted entities (CEs), and providers will soon begin receiving supplemental payments for services rendered to SoonerSelect health and SoonerSelect Children’s Specialty Plan members. These supplemental payments will be lump-sum enhancements to base fees paid by the SoonerSelect contracted entities. 

 As a reminder, providers must meet the following criteria to be eligible for payment under this arrangement:

• In network with a contracted entity. Only in-network paid claims will be evaluated for enhancement. If you are not yet in-network but execute a contract in the contract year (before June 30, 2025), you will become eligible for future incentive payments.
• The rendering provider must be an advanced practice nurse, mid-level practitioner, mental health provider or licensed behavioral health practitioner, podiatrist, physician or anesthesiologist assistant.
• The billing provider cannot be:
• Eligible for a separate State-Directed Payment program, including academic medical center-affiliated physicians and Community Mental Health Centers (CMHCs).
• Clinics, including but not limited to public health clinics, CCBHCs, FQHCs, RHCs, ITU clinics and dental clinics.
• A therapy (OT/PT/ST/RT) group. 

The second round of supplemental payment will be for SoonerSelect paid claims with dates of service between April and September 2024, excluding paid claims enhanced in the initial payment. You will only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced in this payment and future payments. Subsequent supplemental payments will be made after the end of each quarter. 

A few reminders:

• The contracted entities, as directed by OHCA, will distribute these payments. 
• Unless organizations have multiple TINs, they will receive one payment. The payment schedule on the website will list payments by billing provider.
• Contracted entities may reach out to you to set up payment. Please respond, or payment will be delayed.
• Payments may be an electronic funds transfer (ETF), but most payments will be paper checks (mail), which will take 7-10 days. Please reach out to the contracted entities if interested in receiving payment via EFT in future payments.

The SoonerSelect provider incentive program originates from 2022 OK SB1396 and requires approval from the Centers for Medicare & Medicaid Services (CMS). OHCA will evaluate the program design, including eligible providers and payment allocation, annually to ensure the program aligns with the goals of the SoonerSelect Quality Strategy. CMS approval is an annual process, and the program is subject to disapproval or change in future years. The updated payment schedule will be posted as soon as possible at SHOPP Forms and Reports (oklahoma.gov). For additional information, please view the Provider Incentive Directed Payment Program guide.