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Global Messages

2021 Global Messages

Date Posted Title Message
11/19/21 COVID Administration by Dentists

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

11/15/21 COVID-19 Diagnoses

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.

11/15/21 SoonerCare Choice Redesign- 2022 SoonerExcel notification of payment methodology amendment

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.

11/12/21 Claim Processing Updates: Claims Xten and NCCI Edits webinar

 

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.

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

 

11/12/21 CMS Press Release on COVID-19 Vaccinations for Health Care Workers

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.

11/5/21 Contracts Expiring 11/30/21

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.

11/4/21 Dental Prior Authorization Request: Attaching Additional Documents Provider/Specialty Types: 08/080, 081, 086; 27/270-279
 
Prior authorization requests that are missing required documentation will temporarily be electronically returned to providers via the provider portal. Please be sure to review your prior authorization statuses frequently. If you find your authorization in a pending documents status, this means documentation is missing. You have the ability to attach the required documentation to your current authorization. For guidance on how to attach additional documents, please visit: https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/Dental%20Prior%20Authorization%202021.pdf.
11/3/21 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 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.

10/29/21 OHCA School-Based IEP Services Webinar

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.

10/29/21 SoonerCare Choice Redesign: 2022 SoonerExcel changes within the Patient-Centered Medical Home

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. 

10/29/21 Modifier 25 Medical Review Bypass Code List

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.

10/27/21 Public Health Emergency Extension

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.
10/21/21 Dental Prior Authorizations

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.

10/18/21 SoonerCare Adult Expansion Visit Limit Clarification

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.

10/11/21 Periodontal code D4341 Periodontal Scaling and Root Planing – four or more teeth per quadrant

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.

10/11/21 Dental Prior Authorizations

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.

10/6/21 Understanding the Basics of SoonerCare Expansion Webinar

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.

10/4/21 OHCA Public Website Webinar

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.

9/30/21 SoonerCare Choice Redesign - Stakeholder Video

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

9/29/21 Summary of Findings After Nursing Facility Denial

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.

9/28/21 Long-Term Care Cost Reports SFY21

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.

9/27/21

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.

9/27/21 Transition of Expansion Members to Choice

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.  

9/20/21 Individual Dental Contracts Expiring

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.

9/20/21 Vaccine immunization codes 90471 and 90472

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.

9/13/21 SoonerCare Updates and Changes Webinar

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.

9/8/21 Medicaid-Funded Abortion Form Provider Types/Specialties: 01, 31, 52 

Provider Letter 2021-07: RE Policy Revisions and Program Updates -

Effective Sept. 1, 2021, in accordance with Title 63 Oklahoma Statutes 1-741.1, the Certification for Medicaid-Funded Abortion form must be completed by the physician and patient for all Medicaid-funded abortions.

The HCA-67 Certification for Medicaid Funded Abortion form can be found online at https://oklahoma.gov/ohca/providers/forms.html.

Please call the OHCA provider helpline at 800-522-0114 if you have any questions.  
9/7/21 National Correct Coding Initiative and Medically Unlikely Edits Provider Types: 08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 23, 25, 28, 29, 30, 31, 52, 53, 57

Effective October 1, 2021, Oklahoma Health Care Authority will begin to fully implement the National Correct Coding Initiative (NCCI) edits on provider claims. The NCCI program promotes national correct coding methodologies to help control improper coding that could potentially lead to improper payments.

Please reference Provider Letter 2021-12 for more information.

Thank you!
9/2/21 OHCA Secure Provider Portal Functions Webinar Provider Types/Specialties: All

This webinar will provide an overview of the OHCA secure provider portal functionality. Topics will include designation of account roles, functions available through the OHCA secure provider portal including accessing provider letters, reports and searching the fee schedule.

NOTE: Demonstrations and topics related to eligibility, claim or prior authorization submissions will not be covered.

Recommended Audience: All contracted SoonerCare providers and staff that access the OHCA secure provider portal.

Register to attend the OHCA Secure Provider Portal Functions webinar on Thursday, Sep. 16, 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.   
9/1/21 Bariatric Surgery Authorization Update
OHCA has updated it’s policy related to Bariatric Surgery effective 9/1/2021.  Please see OAC 317:30-5-137 for changes. A summary of the changes can be found here and the surgery prior authorization guidelines can be found on the OHCA MAU page.   
8/31/21 C-Section Rate Letters
C-section rate letters for the first six months of state fiscal year 2021 (July – December) are now available through the OHCA Provider Portal.

If you need help to retrieve 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.
8/27/21 Information on the Appropriate Use of Modifiers Provider Types/Specialties: All

The Oklahoma Health Care Authority (OHCA) is providing the following links as a resource to assist Providers in the billing and use of appropriate modifiers, specifically modifiers 25 and 59.

Novitas Modifier 25

Novitas Modifier 59  
8/13/21 SoonerCare Adult Expansion Visit Limit Override Process SoonerCare expansion healthy adult program members may receive four visits per month for physician services. Services that exceed the four visit limit will require a prior authorization (PA) override. The PA is specific to the rendering provider, and a servicing provider number must be entered. Thru codes are not allowed and must contain the specific procedure code. Supporting documentation must include a copy of the visit note and any other documentation that supports medical necessity of the visit. Currently, there is a 30 day retro limit for authorizations to be submitted for many services, but this will be bypassed for these office visits as the need for a PA may not be known prior to the visit.
8/26/21 RE: Provider Letter 2021-10 Claims Processing System Update Provider Types: 08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 22, 23, 25, 28, 29, 30, 31, 52, 53, 57

Due to additional identified testing requirements, OHCA’s implementation of Claims Xten™ is now tentatively set for September 11, 2021, instead of August 27, 2021, as originally scheduled.

You may reference Provider Letter 2021-10 Claims Processing System for further details and expected claim changes with this implementation.

Please call the OHCA provider helpline at 800-522-0114 if you have any questions.   
8/23/21

SoonerRide Program Overview Webinar

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.    

8/23/21 Nursing Facility Pay for Performance (PFP) Payment Update Provider Types: 03/30, 35 SFY2022

1st Quarter PFP payment will be made on August 25, 2021.

We thank you for your continued service to SoonerCare members.  
8/18/21 Individual Dental Contracts Expiring Provider Types: 27, 270-279

Reminder – individual dental provider contracts expire on Sept. 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.  
8/13/21 Dental Copays
Provider Types/Specialties: 270, 271, 272, 273, 274, 275, 276, 277, 278, 080

OK SPA 21-0033 (Dental Copays) was approved on August 9, 2021, with an effective date of July 1, 2021. Providers may charge non-exempt SoonerCare adult members a $4 copay per visit for dental services. Copays do not apply to emergency services. Individuals exempt include: pregnant women; institutionalized individuals; individuals receiving hospice care; American Indians/Alaskan Natives who receive or have ever received services furnished by an Indian health care provider or through referral under contract health services; individuals receiving Medicaid coverage for breast and cervical cancer; and individuals under age 21. Copays are due at the time of the visit. Providers cannot deny service based on a member’s inability to pay a copay. For more information, visit: http://oklahoma.gov/ohca/soonercare-benefits
8/9/21 SoonerCare Expansion Resources Provider Types/Specialties: All

Two SoonerCare expansion resources have been added to OHCA’s public website. “SoonerCare Adult Expansion” features frequently asked questions regarding Medicaid Expansion, and “Adult Expansion Benefits” outlines the new benefits and services available to adult expansion members.

These resources can be found under “Documents” on the Medicaid Expansion page here:  https://oklahoma.gov/ohca/about/medicaid-expansion/expansion.html.

These resources can also be found under “Resources” on the Provider Training page here:  https://oklahoma.gov/ohca/providers/provider-training.html.

Additionally, a provider toolkit can be found at https://oklahoma.gov/ohca/providers/toolkit.html to assist providers in locating helpful tools and resources available on the OHCA public website.
8/9/21 Adult Limited Dental Benefit Resources Provider Types/Specialties: All

Two adult limited dental benefit resources have been added to OHCA’s public website. “Adult Limited Dental Benefit Q&A” features frequently asked questions regarding the new dental benefits, and “Adult Limited Dental Benefit Overview” is a summary of the services covered, as well as those that will require prior authorization.

These resources can be found on the provider dental page here:  https://oklahoma.gov/ohca/providers/types/dental/dental.html.

These resources can also be found under “Resources” on the Provider Training page here:  https://oklahoma.gov/ohca/providers/provider-training.html.

Additionally, a provider toolkit can be found at https://oklahoma.gov/ohca/providers/toolkit.html to assist providers in locating helpful tools and resources available on the OHCA public website.  
8/5/21 Claims Processing
Provider Types: 08, 09, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 23, 25, 28, 29, 30, 31, 52, 53, 57

Effective August 27, 2021, OHCA will begin implementation of a new code editing software system, Claims XTEN.  Professional and DME claims will be processed through this system on this date. Outpatient facility claims are estimated to begin processing the end of 2021.

Please reference Provider Letter 2021-10 Claims Processing System for details and expected claim changes with this implementation.

Thank you!
8/5/21 CPT 81528 Cologuard Coverage Update
Provider Types:  01, 08, 09, 10, 28, 31, and 52

Effective Aug. 1, 2021, OHCA has expanded coverage of CPT 81528 to include ages 45–85, as per the updated United States Preventive Services Task Force (USPSTF) recommendations for colon cancer screenings.

CPT 81528 is the code used to bill for the Cologuard test.

If you have any questions, please call the OHCA provider helpline at 800-522-0114.   
8/5/21 Provider Letters 2021-07 through 2021-09
Provider types/specialties: All  Provider Letters 2021-07 through 2021-09 outline OHCA program and policy updates that will become effective Sept. 1, 2021. For full details about these changes, please visit https://oklahoma.gov/ohca/providers/updates/providerletters.html. 
7/29/21 Introduction to SoonerCare – Part 3 (Coverage & Exclusions)

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

7/29/21 Introduction to SoonerCare – Part 2 (Benefits & Programs)

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

7/27/21 Introduction to SoonerCare – Part 1 (Eligibility & Verification) Provider Types/Specialties: All

OHCA will present a webinar titled Introduction to SoonerCare – Part 1 (Eligibility & Verification) on Thursday, Aug. 12 from 2 p.m. to 3:30 p.m.

This class is part one of a multi-series of “Introduction to SoonerCare” which 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 to attend the Introduction to SoonerCare – Part 1 (Eligibility & Verification) webinar on Thursday, Aug. 12 from 2 p.m. to 3:30 p.m.: 

Expired Link
  
7/20/21 Public Health Emergency Extension

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.
7/20/21 Oklahoma Health IT Survey

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.       

7/20/21 Reminder - Electronic Submissions for PASRR Level 1 (LTC-300R) 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 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
7/15/21 Soonercare Expansion Webinar Dates

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.

Thursday, July 29, 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.
7/12/21 OHCA Training Survey Provider Types/Specialties: All

The Oklahoma Health Care Authority strives to provide effective trainings to contracted SoonerCare providers. To better understand the training needs of providers and their staff, OHCA requests and welcomes feedback from the provider network by completing a two minute survey which will expire after two weeks.

Thank you for your participation and passion to serve SoonerCare members.

Click here to complete the two minute survey: https://www.surveymonkey.com/r/XRNJFYS.
7/12/21 Electronic Submissions for PASRR Level 1(LTC-300R)

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.

7/9/21     SoonerCare Adult Expansion Webinars

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.    

7/8/21 Dental Updates and Changes webinar   OHCA will be presenting a webinar titled Dental Updates and Changes on Tuesday, July 27, 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 Updates and Changes webinar on Tuesday, July 27, 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.   
7/6/21 Dental Contracts Expiring

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. 

7/6/21 Adult SoonerCare Eligibility Verification

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”. 

7/6/21 EDEA Agreement

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.

7/1/21 Expansion Adults

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.

7/1/21 Adult Dental Benefits
Provider Types: 080, 270-278

Effective July 1, SoonerCare adults are eligible for additional dental benefits including dental cleanings, exams, X-rays, periodontal scalings, resin and amalgam restorations, and full and partial dentures. Please find a more comprehensive guide at the following website: https://oklahoma.gov/ohca/individuals/soonercare-dental.html.  
7/1/21 Healthy Adult Program Provider Types: All

Effective July 1, 2021, newly eligible expansion adults are in a new eligibility group called the Healthy Adult Program (HAP).

When checking eligibility on the OHCA secure provider portal for new adult SoonerCare members, Healthy Adult Program (HAP) will display as the program of eligibility.  In order to ensure coverage for services, use the Search Fee Schedule feature that is located under the Resources tab in the secure provider portal. 

For questions, please contact the OHCA Call Center at 1-800-522-0114, option 1.  
6/28/21 SFY2021 Cost Report Provider Types/Specialties: 03/030, 031, 034, 035

This is a reminder to LTC providers that all cost reports for the State Fiscal Year ending June 30, 2021, will be due on or before October 31, 2021.

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

A new cost classification titled Oxygen Only has been added to the Drug and Medical Supply LTC Cost Reporting section of the provider portal. All LTC providers who need to report oxygen as an expense, must report that amount in the box titled “Oxygen Only”.

Thank you for the services you provide to SoonerCare members.  
6/23/21 Introduction to SoonerCare – Part 2 (Benefits and Programs) Provider Types: All

OHCA will be presenting a webinar titled Introduction to SoonerCare – Part 2 (Benefits and Programs) on Thursday, July 22 from 2:00 p.m. to 3:30 p.m.

This class is part two of a series titled 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 to attend the Introduction to SoonerCare Part 2 webinar here:
Expired Link.

After registering, you will receive a confirmation e-mail containing information about joining the webinar.
6/15/21 Dental Updates & Changes webinar  

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.

6/15/21 Introduction to SoonerCare – Part 1 (Eligibility & Verification)   Provider Types: All

OHCA will present a webinar titled "Introduction to SoonerCare – Part 1 (Eligibility & Verification)" on Thursday, July 15, 2021 from 2 p.m. to 3:30 p.m.

This class is part one of a multi-series of Introduction to SoonerCare. 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 to attend the Introduction to SoonerCare – Part 1 (Eligibility & Verification) 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. 
6/14/21 2021 EHR Incentive Attestations
Provider Types/Specialties:  08, 09, 10, 16, 27, 31, 52

Providers may now submit their program year 2021 attestations!

Program year 2021 is the last year to participate in the program. As outlined in statute (https://www.federalregister.gov/d/2010-17207/p-3158), all incentive payments must be issued by Dec. 31, 2021; therefore, this will impact the typical attestation timeframe for program year 2021. Providers will have until Aug. 31, 2021 to submit their program year 2021 attestation to allow OHCA ample time to review the attestation and pay the incentive to the provider by the Dec. 31, 2021 deadline. No payments will be made after this date.

The reporting period will be any 90-day period between Jan. 1, 2021 and Aug. 31, 2021. Providers attest to a 90-day reporting period for both meaningful use and clinical quality measures, and all 2021 attestations must be submitted by Aug. 31, 2021.

If you have any questions or concerns regarding this program, please contact the EHR incentive team at EHRIncentive@okhca.org or by phone at 405-522-7347. You can also visit us online at https://oklahoma.gov/ohca/about/office-of-public-information/oklahoma-electronic-health-record-incentive-program.html.
6/9/21 Electronic Dental Prior Authorizations & Dental Claims Effective July 1, Oklahoma Health Care Authority (OHCA) will transition to a fully electronic prior authorization (PA) and claims process. All dental claims and PAs, and any related documents, should be submitted electronically through the SoonerCare provider portal. Mailed PAs and claims will no longer be accepted. OHCA will no longer accept paper documents or diagnostic models. Radiographic and photographic images must also be submitted electronically. PA status notifications will continue to be available through the SoonerCare provider portal. The PA notification process for members will also remain the same.
6/8/21 SoonerCare Notification of Date of Service (NODOS) webinar Provider Types/Specialties:  01, 63

OHCA will present a webinar titled "SoonerCare Notification of Date of Service (NODOS)" on Wednesday, June 16 from 1 p.m. - 2:30 p.m.

This training will offer facility staff the opportunity to be educated on how NODOS works and notify OHCA of needed medical services for potential members.

Target audience:
Inpatient hospital facilities and inpatient crisis intervention facilities.

Register for the SoonerCare Notification of Date of Services webinar here: Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.  
6/7/21 Update: SoonerSelect
Provider Types/Specialties: All

Due to Oklahoma Supreme Court decision 2021 OK 30, the Oklahoma Health Care Authority has paused implementation of SoonerSelect. Please continue to monitor our website for updates.
6/1/21 Telehealth ends for Physical Therapy Effective immediately and per the Oklahoma Board of Medical Licensure and Supervision, the use of telehealth in physical therapy has ended. The Governor’s Executive Order, which allowed physical therapy to utilize telehealth during the pandemic, ended May 4, 2021.
5/21/21 Pfizer BioNtech Covid-19 Vaccine Expanded Coverage Provider Types: All

In keeping with the FDA emergency use authorization and CDC Advisory Committee on Immunization Practices (ACIP) approval, OHCA has expanded coverage for Pfizer BioNtech Covid-19 vaccine and administration to include ages 12 to 15, effective 5/10/2021.

The Pfizer BioNtech Covid-19 vaccine code 91300 and administration codes 0001A and 0002A are now covered by SoonerCare for ages 12 and older.

If you have any questions, please call the OHCA provider helpline at 800-522-0114.  
5/11/21 SoonerSelect (Dental) Reminder: OHCA will be presenting a SoonerSelect Dental webinar on Thursday, May 13 from 10 a.m. – 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 MCOs/DBPs and responsibilities of OHCA.

Recommended audience: All SoonerCare dental providers.

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.   
5/5/21 SoonerSelect Basics Webinars
OHCA will be presenting webinars titled SoonerSelect Basics during May and June 2021. Additional training dates will be posted at a later time.

The classes are provider type specific and will provide an overview of the upcoming Managed Care Organization (MCO) changes. Topics include transition to managed care, member populations affected by the transition, contracting with an MCO, requirements of the MCOs and responsibilities of OHCA.

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

Select the registration link below to attend the webinar session for your provider type:

Hospital Providers:
Tuesday, May 18 from 10 a.m. – 11:30 a.m.
Expired Link.

Physicians and Physician Groups:

Thursday, May 20 from 2 p.m. – 3:30 p.m.
Expired Link.

Behavioral Health:
Tuesday, May 25 from 10 a.m. – 11:30 a.m.
Expired Link.

Occupation, Physical and Speech/Language Pathology:
Thursday, May 27 from 10 a.m. – 11:30 a.m.
Expired Link.

Durable Medical Equipment (DME):
Tuesday, June 1 from 1 p.m. – 2:30 p.m.
Expired Link.

Pharmacy: 
Thursday, June 3 from 10 a.m. – 11:30 a.m.
Expired Link.
5/2/21 SoonerSelect (Dental)

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.

4/30/21 Prior Authorizations Virtual Town Hall OHCA will host town hall meetings throughout the state and virtually to answer provider and stakeholder questions about our new managed care program, SoonerSelect. Please complete the below registration form if you plan to attend this virtual-only town hall about prior authorizations.

Register to attend here: https://oklahoma.gov/ohca/townhall/prior-authorizations

Look for a link to join the webinar after completing the registration form. The meeting will be recorded, and a replay will be available at a later date.

Date and Time
Wednesday, May 5  3:30 - 4:00 PM

Location
Online webinar via Zoom.  
4/22/21 Important Dates
Provider Types/Specialties:  All

Medicaid Expansion - July 1, 2021:
Oklahomans voted to expand SoonerCare eligibility to adults ages 19-64 whose income is 138% of the federal poverty level or lower. This equates to an estimated annual income of $17,796 for an individual or $36,588 for a family of four. Members may begin to enroll in Medicaid expansion on June 1, 2021.

SoonerSelect - Oct. 1, 2021: SoonerSelect goes in effect on October 1. How does this impact medical and dental providers who see SoonerCare members? Medical and dental providers must contract with at least one of the plans to continue serving SoonerCare members (excluding those included in our aged/blind/disabled population, home and community-based waiver members, dual eligible populations and TEFRA children).
4/19/21 School-Based Contract Renewal
Provider Types/Specialties: 12/120, 126

School-based contracts and school-based paraprofessional contracts that expire on June 30, 2021 may now be renewed via the OHCA secure provider portal. Visit the provider training page at https://oklahoma.gov/ohca/providers/provider-training.html for a how-to video on Renewing your SoonerCare Contract.  
4/20/21 Dental Prior Authorization Documentation Provider Types/Specialties: 27/270-278, 08/080

Effective immediately, all required documentation must be submitted at time of prior authorization request. Prior authorizations submitted without the required documentation will be cancelled due to insufficient documentation for comprehensive review and will no longer be electronically returned to the provider for attachment of required documentation.
4/19/21 Public Health Emergency Extension

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.
4/13/21 Managed Care (SoonerSelect) What you need to know about managed care (SoonerSelect)

OHCA is transitioning to a managed care delivery service model in partnership with four medical plan organizations and three dental plan organizations. The following SoonerCare populations will be asked to choose from one of the four health plans:  children (including foster children), low-income parents, pregnant women, and adults ages 19 – 64 (expansion population). American Indian/Alaska Native members are considered voluntary and will have the option to opt-in to a managed care plan.

When will SoonerSelect go into effect? Oct. 1, 2021

How does this impact providers who see SoonerCare members?  Providers who serve our members that will be transitioning into managed care will need to contract with our partner plans in order to continue serving those members. Members will be able to choose which plan they will join.

How can I learn more? Visit https://oklahoma.gov/ohca/about/soonerselect.html for more information on SoonerSelect.

SoonerSelect Town Halls
OHCA is hosting town hall meetings throughout the state to answer provider and stakeholder questions about our new managed care program, SoonerSelect. All town halls have in-person and virtual attendance options. To stay up-to-date on the latest information regarding Town Halls, visit: https://oklahoma.gov/ohca/townhall.
4/12/21 Kingfisher and Oklahoma City Town Hall Global Message OHCA will host town hall meetings throughout the state to answer provider and stakeholder questions about our new managed care program, SoonerSelect. Please complete the below registration form if you plan to attend — either virtually or in-person — the town halls in Kingfisher or Oklahoma City. The meeting will be recorded, and a replay will be available at a later date.

Register to attend here: https://oklahoma.gov/ohca/townhall.html   

Date and Time
Kingfisher:
Thursday, April 15
10:00 - 11:00 AM

Oklahoma City:
Monday, April 19
10:00 – 11:30 AM

Location
Kingfisher:
Kingfisher County Fairgrounds
Exhibit Building
300 South 13th St.
Kingfisher, OK 73750

Oklahoma City:
OKC MetroTech - South Bryant Campus
4901 South Bryant Ave.
Oklahoma City, OK 73129  
4/7/21 Unlocking Implicit Bias Training    

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.

4/5/21 Poteau Town Hall

OHCA will host town hall meetings throughout the state to answer provider and stakeholder questions about our new managed care program, SoonerSelect. Please complete the below registration form if you plan to attend — either virtually or in-person — the town hall in Poteau. The meeting will be recorded, and a replay will be available at a later date. 

Date and Time
Wednesday, April 7
1:00 - 2:00 PM

Location
Kiamichi Technology Seminar Center
1509 S McKenna St
Poteau, OK 74953
4/1/21 OSDH Seeking Providers for COVID-19 Vaccine Administration The Oklahoma State Department of Health is seeking interested providers to administer the COVID-19 vaccine to eligible Oklahomans. Any facility, organization, or health care provider licensed to possess vaccine, administer vaccine, or provide vaccination services in Oklahoma is eligible to enroll.

Visit https://oklahoma.gov/covid19/providers/provider-enrollment-process.html for information and to enroll.  
4/1/21 Insure Oklahoma Population Changes   Oklahoma’s Medicaid program, SoonerCare, currently covers only children, pregnant women, elderly adults and disabled individuals.

On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed to expand Medicaid eligibility to adults ages 19-64 whose income is 138% (133% with a 5% disregard) of the federal poverty level or lower. This equates to an estimated annual income of $17,796 for an individual or $36,588 for a family of four.

As OHCA prepares for the expanded adult Medicaid population, the current Insure Oklahoma premium assistance program will be modified due to population changes. There are two Insure Oklahoma programs, Individual Plan (IP) and Employer Sponsored Insurance (ESI).

As Oklahoma adds the expansion adult population, the ESI program will be revised to cover individuals with qualifying income from 138% to 200% of the federal poverty level starting July 1, 2021. Insure Oklahoma will continue to accept applications from small businesses who want to join the premium subsidy program. The IP members will be moved into the new expansion population.

Approximately 21,000 of the currently enrolled IP and ESI members will become covered as expansion adults. As adults who are 19 through 64 years old with lower income levels are moved to expansion adult coverage, they will not pay a premium for coverage in SoonerCare.
3/30/21 Duncan Town Hall

OHCA will host town hall meetings throughout the state to answer provider and stakeholder questions about our new managed care program, SoonerSelect. Please complete the below registration form if you plan to attend — either virtually or in-person — the town hall in Duncan. The meeting will be recorded, and a replay will be available at a later date.

Date and Time
Thursday, April 1
2:30 - 3:30 PM 

Location
Red River Technology Center
3300 W Bois D'Arc Ave
Duncan, OK 73533
3/26/2021 Medical Authorization Using InterQual® Webinar OHCA will be presenting a webinar titled: ‘Medical Authorization Using InterQual®’ on Thursday, April 29 at 2PM.

This class covers the prior authorization (PA) submission for InterQual®-related procedures and provides resolutions to common errors within the InterQual® review. PAs related to behavioral health, dental, DME, Therapy (OT/PT/ST), pharmacy and waivers are not included. Note: This webinar will not include Managed Care Organization (MCO) changes or Medicaid Expansion. For more information about MCOs or Medicaid expansion, visit our home page and click on one of the banners toward the center of the page.

Recommended Audience: Providers who submit PAs related to surgeries, procedures and high tech imaging.

Register to attend the ‘Medical Authorization Using InterQual®’ on Thursday, April 29 at 2PM: Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.
3/22/2021 SoonerSelect Town Halls
Provider Types: All

Attention Providers: Save-the-date for one of our town hall meetings to discuss the transition to managed Medicaid. Our experts will be on hand to answer all your questions, as will representatives from our chosen medical and dental partners.

Please register for the event as COVID-19 guidelines will be enforced at each facility. A virtual option will be provided if you are unable to attend in-person. If you don't see your location listed, please check back as we are scheduling more locations.

https://oklahoma.gov/ohca/townhall.html
3/19/2021 Portal Access Form
Provider Types: All

The Provider/Administrator Portal Access Form has been updated. This form should only be utilized by providers and provider portal administrators to obtain a temporary password, reset challenge questions, receive a new PIN letter, or receive a user ID. The new version can be viewed and utilized from the following link: https://oklahoma.gov/ohca/providers/claim-tools/claim-tools.html, including an instructional video to assist in completing the document.

Providers/Administrators should complete the form electronically and send to the Provider Internet Helpdesk upon completion. Faxing the document is no longer allowed. The new document will go into effect immediately and beginning May 1, 2021 the old form will no longer be accepted. Please allow a minimum of 48 hours for completion of these requests.
3/15/2021 SoonerCare Provider and Stakeholder SoonerSelect Survey The Oklahoma Health Care Authority, in partnership with managed care organizations, will transition to a new health care model through SoonerSelect.

We understand our providers and stakeholders have many questions about managed care. OHCA will send out a survey to providers, and the survey responses will help us to create informational materials to answer your questions.

We have created a Survey for Providers and Stakeholders that will help us create informational materials to answer your questions. Please click on the link above and take a few minutes to submit your survey responses.

OHCA will host town hall meetings throughout the state in late March and April to answer provider and stakeholder questions. For more information about upcoming town halls, visit www.oklahoma.gov/ohca/townhall.  
3/12/2021 Dental Prior Authorizations Provider Types: Provider Types 08 (080 & 086) and 27 (271-275)

This class 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 on the SoonerCare Provider Portal. Note: This webinar will not include dental Managed Care Organization (MCO) changes or Medicaid Expansion. For more information, click on the banner from the homepage.

Recommended Audience:Dentists, Orthodontists, Administrative Staff

Register to attend the ‘Dental Prior Authorizations’ on Wednesday, April 7 at 2PM: Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.
3/9/2021 Hospital Contracts Expiring
Provider Types: 01 - Hospitals

Hospital contracts expire on March 31, 2021. To avoid any delay in reimbursement, we encourage hospitals to submit their renewals as soon as possible.

If you have any questions, please contact provider enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org.
3/3/2021 COVID-19 Monoclonal Antibodies

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.

3/2/2021 Covid-19 related Private Duty Nursing (PDN) Overtime claims subject to timely filing Provider Types/Specialties: 05, 16, 50, 51, 163

As previously announced in a 5/29/2020 global message, effective March 1, 2020 and for the duration of the COVID-19 public health emergency, private duty nursing (PDN) providers may submit claims to receive a higher rate of pay for PDN hours that result in overtime rate of pay for nursing staff. Only PDN services for persons with tracheostomies or who are ventilator dependent are qualified for the overtime payment.

Please be advised that these overtime claims are subject to standard timely filing rules.The initial claim to receive the regular rate of pay for PDN services must be filed within 6 months of the date of service, and the subsequent overtime claims for qualified private duty nursing care must be submitted within one year of the date of service.

Full instructions for overtime claim submissions are contained in the 5/29/2020 global message titled “Private Duty Nursing Overtime Rate, COVID-19 related.”

Questions may be directed to Carolyn Reconnu-Shoffner, Director, Population Care Management, at 405-522-7630, or Kim Downing, Care Management Supervisor, at 405-857-2364.
3/1/2021 COVID-19 Vaccine Coverage Update

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.

2/25/2021 Introduction to SoonerCare - Part Three
Provider Types: All

OHCA will be presenting a webinar titled “Introduction to SoonerCare – Part Three (Coverage & Exclusions)” on Thursday, March 25 at 2 p.m.

This class is part three of a series titled “Introduction to SoonerCare”. Attendees will learn more about the services available with basic Medicaid coverage for both adults and children, as well as exclusions and limitations. Coverage for waiver programs, including Advantage and Home and Community Based Waiver Services, will not be part of this webinar.

Recommended Audience: New Oklahoma Medicaid providers and staff.

Register to attend the “Introduction to SoonerCare – Part Three (Coverage & Exclusions)” webinar on Thursday, March 25 at 2 p.m. using the link below.

Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.
2/23/2021 Nursing Facility Pay for Performance (PFP) Payment Update Provider Types/Specialties: 03/30, 35

SFY2021 Third Quarter PFP payment will be made on Feb. 24, 2021.

We thank you for your continued service to SoonerCare members.
2/23/2021 Introduction to SoonerCare - Part Two
Provider Types: All

OHCA will be presenting a webinar titled Introduction to SoonerCare – Part Two (Programs) on Thursday, March 11, 2021 at 2 p.m.

This class is part two of a series titled Introduction to SoonerCare. Attendees will learn more about the various Oklahoma Medicaid member benefits and programs. Demonstrations will be provided on how these plans appear on the provider portal when conducting an eligibility search.

Recommended Audience: New Oklahoma Medicaid providers and staff.

Register to attend the Introduction to SoonerCare – Part Two (Programs) webinar on March 11, 2021 at 2 p.m.

Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.
2/2/2021 Electronic Submissions for PASRR Level I and Level II

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.

1/26/2021 Introduction to SoonerCare - Part One
Provider Types: All

OHCA will be presenting a webinar titled: Introduction to SoonerCare – Part One (Medicaid Eligibility & Verification) on Thursday, Feb. 25 at 2 p.m.

This class is part one of a multi-series of Introduction to SoonerCare. 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 to attend the Introduction to SoonerCare – Part One (Medicaid Eligibility & Verification) webinar on Thursday, Feb. 25 at 2 p.m.: Expired Link.

After registering, you will receive a confirmation email containing information about joining the webinar.
1/21/2021 Anterior and Posterior Root Canal Prior Authorizations

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. 

1/20/21 Hospital Addendum for Psych and Rehab Units

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.

1/19/20
Therapy Assistant Enrollment PV Specialties: 087, 120, 126, 145, 170, 171, 173, 174, 175, 179, 182

In regard to provider letter 2021-02, therapy assistants may now enroll at https://oklahoma.gov/ohca/providers/provider-enrollment.html. The agency has extended the deadline to April 1, 2021 for all enrollments to be submitted. During this time, billing under the licensed therapist is still permitted if needed.

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

1/15/21 Public Health Emergency Extension

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.
1/12/21 Provider Letter 2021-02

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.

1/12/21 Provider Letter 2021-01

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.

1/5/21 ADA Dental Claim Submission
Provider Types: 08, 27
Specialty Types: 086, 270-279

OHCA will be presenting a webinar titled ADA Dental Claim Submission on Thursday, February 4 at 2 p.m.

This class will provide an in-depth look at the electronic ADA dental claims submission on the secure provider portal. Attendees will learn more about the policy and procedures of submitting Medicaid primary and Medicaid secondary claims. General coding for services will not be addressed in this presentation.

Recommended Audience: Billing staff who submit ADA dental claims.

Register to attend the ADA Dental Claim Submission on February 4 at 2 p.m.
Click Here to Register

After registering, you will receive a confirmation email containing information about joining the webinar.
1/4/21 C-Section Rate Letters
Provider Types: 01, 08, 31, 52
 
The year-end C-section rate letters for state fiscal year 2020 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.
Hospital Addendum for Psych and Rehab Units
Last Modified on Nov 19, 2021