Global Messages
2024 Global Messages
| DATE POSTED | TITLE | MESSAGE |
|---|---|---|
| 12/20/24 | Professional Dental Consultations | Provider Types: 27/270-279, 08/080 & 086 Provider letter 2024-29 Professional Dental Consultations is now available on the provider letters page of the OHCA website. The letter informs providers of appropriate billing practices and guidelines for a D9310. Providers who render D9310s are strongly encouraged to review the guidance to ensure all requirements have been met for billing purposes. |
| 12/12/24 | PA for Septoplasty CPT 30520 | Provider Types: 01, 02, 09, 10, 27, 31, and 52 Effective Feb. 1, 2025, OHCA will require a prior authorization for CPT 30520 – Septoplasty. For SoonerCare members not enrolled in a SoonerSelect plan, authorization will be completed through the provider portal where InterQual criteria will be utilized. For members enrolled in a SoonerSelect plan, providers will need to contact the plan for specific coverage and PA guidelines. |
| 12/4/24 | Infrastructure and Needs Assessment for School-Based Services in a School Setting | Provider Types: 07, 08, 09, 10, 11, 12, 13, 16, 17, 18, 19, 20, 21, 23, 31, 36, 52, 53 Please complete the school-based services assessment survey by Dec. 20, 2024. The Oklahoma State Department of Education and the Oklahoma Health Care Authority is conducting a comprehensive infrastructure and needs assessment to improve school-based Medicaid reimbursement and ensure students have access to the health care resources they need to thrive in a school setting. This assessment evaluates existing systems, identifies gaps and informs strategies for better Medicaid-funded services in schools. Your input is vital and we encourage parents, community members, tribal officials, school district administrators, medical providers and school staff to participate. The survey will take about 10-20 minutes, depending on your role, and your feedback will help shape equitable and effective solutions. Please complete the survey by Friday, Dec. 20 to ensure your voice is included in this important initiative. Together, we can strengthen the framework for student health and well-being. Infrastructure and Needs Assessment Survey If you have any questions, please email SBSMedicaid@sde.ok.gov. This survey is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2.5 million with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. government. |
| 12/3/24 | Enteral Nutrition PA Submission Clarification | Provider types: 08, 09, 10, 25, 31, 52 This is to clarify medical guidelines and documentation requirements. Prior Authorization submissions for enteral nutrition must contain all of the following:
Requests that do not contain all of the information listed above will be canceled as an incomplete request. Additionally, pumps are rented as a capped rental for up to 13 months of continuous use. After that, they are converted to a purchase. Full guidelines are listed on OHCA’s durable medical equipment page. |
| 11/27/24 | Long Term Care Enhanced Payment Update | ICF/IID Vocational & Day Services Enhanced Payment - Update Run Date: 11/26/2024 – 12/06/2024 PV Type: 03/ 31,34 The SFY 2025 2nd quarter enhanced payment for vocational and day services will be made on Nov. 27, 2024. We thank you for your continued service to SoonerCare members. |
| 11/27/24 | Provider weekly payments | Provider types: All The Nov. 27 and Dec. 4, 2024 provider payments will occur as scheduled and will not be disrupted by the Thanksgiving holiday. The Dec. 25, 2024 provider payments will be delayed one day due to the Christmas holiday. Provider payments will be deposited on Thursday, Dec. 26, 2024. The Jan. 1, 2025 provider payments will be delayed one day due to the New Year’s Day holiday. Provider payments will be deposited on Thursday, Jan. 2, 2025. |
| 11/27/24 | Extension of expiration date of Physician contracts | Provider Type: All OHCA has extended the expiration date of physicians from Nov. 30 to Dec. 31, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members. We currently have over 12,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit renewals as soon as possible. You can log into the provider portal to complete your renewal. If you need assistance logging into the portal, please contact our internet helpdesk at 800-522-0114, option 2, option 1, or via email at SoonerCareInternetHelpdesk@gainwelltechnologies.com. |
| 11/26/24 | DentaQuest Change in Service Provision | Provider Types: 27/270-279, 08/080 & 086 Provider Letter 2024-27 SoonerSelect Dental Changes to Claims Processing for Therapeutic Pulpotomies, Gross Pulpal Debridement and Endodontic Therapy for DentaQuest is now available on the provider letters page of the OHCA website. The letter informs providers that DentaQuest will implement changes related to claims processing for therapeutic pulpotomies, gross pulpal debridement and endodontic therapy for dates of services on or after Dec. 9, 2024. |
| 11/26/24 | Long Term Care PFP Payment Update |
Nursing Facility Pay for Performance (PFP) Payment Update Run Date: 11/26/2024 – 12/6/2024 PV Type: 03/30, 35 The SFY 2025 2nd quarter PFP payment will be made on Nov. 27, 2024. We thank you for your continued service to SoonerCare members. |
| 11/15/24 | HIE Connect Event for Long-Term Care Providers | Provider Types: 03, 06 The Office of the State Coordinator for Health Information Exchange (HIE), along with the State Designated Entity, MyHealth Access Network, and partners at OFMQ invite you to an in-person HIE Connect Event for long-term care providers. The event will be held from 3-6 p.m., Tuesday, Dec. 3. It’s an opportunity for long-term care providers to discover how the HIE can streamline continuity of care, offer access to resident data, improve care coordination, and explore cost saving opportunities through OKSHINE programs. View more details or register for the event. |
| 10/30/24 | Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program Change in Service Provision | PV Type: All Provider Letter 2024-20 PA Criteria for MRI of the Lumbar Spine for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program is now available on the the provider letters page of the OHCA website. The letter informs providers that Oklahoma Complete Health and Children’s Specialty Program will implement changes related to PA criteria for MRI of the Lumbar Spine for dates of services on or after November 1, 2024. |
| 10/28/24 | SoonerCare Low-Dose CT Lung Cancer Screening Overview Webinar |
Provider Types/Specialties: 01, 08, 09,10, 11, 16, 31, 52 The Oklahoma Health Care Authority, in partnership with the Oklahoma Hospital Association, will present a SoonerCare webinar at noon, Thursday, Nov. 7. Register here. Providers will be introduced to components of SoonerCare’s low-dose CT lung cancer screening benefits. Topics to be explored include CMS updated guidelines, Oklahoma State of Lung Cancer Report, most updated eligibility criteria for Medicaid, shared decision-making visit requirements, the importance of continued tobacco cessation counseling and follow ups, and billing and coding information. The webinar is available for all SoonerCare providers interested in ensuring that they are up to date with the most recent CMS guidelines for SoonerCare’s low-dose CT lung cancer screening benefits, as well as for providers who can perform and bill for the shared-decision making and CT screening. |
| 10/28/24 | SoonerCare: Vaccinations at the Pharmacy Webinar | Provider types: 24/240, 241 Register for a webinar at 10 a.m., Wednesday, Nov. 6, 2024, to learn about recent SoonerCare policy changes that allow vaccinations to be performed in the pharmacy by a pharmacist. This change is effective Nov. 1, 2024. Pharmacy groups, pharmacists and staff will learn about contracting requirements, coverage and services, billing requirements, and utilizing the secure provider portal. |
| 10/25/24 | Extension of expiration date of Physician contracts | Provider Type: 31/All Specialties OHCA has extended the expiration date of physician contracts from Oct. 31, 2024 to Nov. 30, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members. We currently have over 14,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit renewals as soon as possible. You can log into the provider portal to complete your renewal. If you need assistance logging in, please contact the helpdesk at 800-522-0114, option 2, option 1. Or you can email SoonerCareInternetHelpdesk@gainwelltechnologies.com. |
| 10/23/24 | PA Added for CPT 81595 – AlloMap | Provider types: 01, 08, 09, 10, 28, 31, and 52 Effective Nov. 1, 2024, OHCA will require a prior authorization for CPT 81595 – cardiology heart transplant MRNA (AlloMap). Prior authorization guidelines for this molecular pathology testing can be found on the OHCA website. |
| 10/21/24 | Maintenance Notification (Updated) | Type: ALL OHCA and Gainwell will be implementing security updates to strengthen the overall data protection of our provider portal on Nov. 7, 2024. Most users will not be affected by these changes, but billing agencies, software companies and other trading partners should be aware that we are upgrading the hashing algorithm to a more current and secure version. If you have issues logging in on Thursday, Nov. 7, please contact your vendor or our EDI Helpdesk at 800-522-0114 option 2, 2. |
| 10/17/24 | Developmental Testing 96112/96113 and Neurobehavioral Status Exam 96116/96121 | Provider types: 08, 09, 10, 13, 17, 31, and 52 Effective Nov. 15, 2024, OHCA will require a prior authorization for developmental testing codes 96112/96113 and neurobehavioral status exam codes 96116/96121 when performed by a medical provider. Prior authorization for this testing is already required for behavioral health providers and there are no changes to that process. This change is being made in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) which ensures parity between behavioral health services and medical services. Prior authorization guidelines for medical providers can be found on the OHCA website. |
| 10/09/24 | Over $11.5 Million in Supplemental Payments Paid by SoonerSelect Contracted Entities | Provider Types: 08, 09, 10, 11, 14, 31, 53, and 60 Thank you for your patience as we set up this new incentive payment program. Last week, eligible providers began 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:
The initial supplemental payment will be for SoonerSelect paid claims with dates of services between April and June 2024. You will only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced in this and future payments. Subsequent supplemental payments will be made after the end of each quarter.
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. For a payment schedule, please view at SHOPP Forms and Reports (oklahoma.gov). For additional information, please view the Provider Incentive Directed Payment Program guide. |
| 10/07/24 | Long Term Care Cost Reports SFY24 | Run Date: 09/30/2024 – 10/31/2024 PV Type: 03/30, 31, 34, 35 Long-term care provider cost reports for SFY 24 are due by Oct. 31, 2024. Facilities may be subject to a rate reduction, equal to the amount of the direct care portion of the daily rate, ranging from $36.10 to $73.38 per patient day, if cost reports are not received in a timely manner. Thank you for your attention to this matter. |
| 10/03/24 | Coverage for 87631 – Respiratory Panel Testing | Providers: 01, 08, 09, 10, 28, 31, 52 Effective Oct. 1, 2024, OHCA is expanding coverage for 87631 (RESP 3-5 TARGETS). This code was previously only covered in the outpatient hospital setting, but OHCA will now reimburse for this testing when performed by a hospital laboratory, physician/clinic lab, or independent lab for medically necessary covered indications. OHCA has updated the Molecular Diagnostic Testing for Infectious Diseases coverage guideline with the information below. This coverage guideline can be found on the Medical Authorization Unit web page 87631 – Respiratory virus (e.g., adenovirus, influenza, coronavirus, metapneumovirus, parainfluenza virus, RSV, rhinovirus) includes multiplex reverse transcription when performed, and multiplex amplified probe technique, multiple types, or subtypes, 3-5 targets. • Testing covered when performed by a hospital lab, independent lab or clinic lab for the following indications:
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| 10/1/24 | Extension of Expiration Date of Physician Contracts | Provider Type: 31/All Specialties OHCA has extended the expiration date of physicians from Sept. 30, 2024, to Oct. 31, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members. There are currently more than 14,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit renewals as soon as possible. You can log into the provider portal to complete your renewal. If you need assistance logging into the provider portal, please contact our helpdesk at 800-522-0114, option 2, option 1, or via email at SoonerCareInternetHelpdesk@gainwelltechnologies.com. |
| 9/27/24 | Continuity of Care Provision | Provider Types/Specialties: All The continuity of care provision extension for provider contracting with our partners Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health to be in-network and reimbursed at 100% of the SoonerCare fee schedule is ending Oct. 1. Therefore, if you are not fully contracted with the plans by Oct. 1, you will be considered out-of-network, and the reimbursement rate will be at 90% of the SoonerCare fee schedule. |
| 9/26/24 | Aetna Change in Service Provision | Provider Types/Specialties: All Provider Letter 2024-19 SoonerSelect Cumulative Refill Too Soon Threshold for Aetna Better Health of Oklahoma is now available on the provider letters page of the OHCA website. The letter informs providers that Aetna Better Health of Oklahoma will implement changes related to pharmacy refill thresholds for dates of service on or after Oct. 1, 2024. |
| 9/23/24 | EHR Vendor Webinar | PROVIDER TYPES: 01, 02, 03, 05, 06, 08, 24, 25, 26, 28, 29, 30, 63 The Oklahoma Health Care Authority and the Office of the State Coordinator for Health Information Exchange are hosting a webinar to discuss the integration of Electronic Heath Records (EHRs) with the Health Information Exchange (HIE). It will take place from 11 a.m.-12:30 p.m., Thursday, Oct. 10. The session will explore the collaborative efforts required between health care providers and their EHR vendors to effectively connect to the HIE and facilitate seamless data sharing across systems. It will also highlight available State of Oklahoma funding options for EHR systems and health care providers to support this integration. Key takeaways for attendees will include:
Forward this message to your EHR vendor representative(s) to ensure they have an opportunity to attend. Vendors are encouraged to register today to ensure their customers are well-prepared for successful HIE integration and compliant with data blocking regulations. |
| 9/20/24 | Taxonomy Q&A sessions with our Partners | Provider types: All Message: Do you have taxonomy issues, questions, or problems? Great news! OHCA, in conjunction with our partners, is hosting Q&A sessions for providers to ask the experts. The sessions will occur every other Tuesday at 10 a.m. from Sept. 24-Dec. 31, 2024. When you register, you will be automatically signed up for every session. Attend as many sessions as you would like. |
| 9/17/24 | Hernia Repair in Ambulatory Surgery Center | Provider Types: 02, 08, 31, and 52 Effective Sept. 1, 2024, OHCA has extended coverage for hernia repair codes 49591, 49592, 49593, 49594, 49595, 49613, 49614 and 49615 to allow reimbursement when provided in an ambulatory surgery center. |
| 9/17/24 | Coverage added for CPT 81517 | Provider Types: 01, 08, 09, 10, 28, 31 and 52 Effective Sept. 1, 2024, OHCA has opened coverage for CPT 81517, a serum based enhanced liver fibrosis (ELF) test. It will be allowed up to two times per year for members with chronic liver disease for whom liver fibrosis determination is necessary. |
| 9/16/24 | PA for HCPCS E0760 – ultrasound bone growth stimulator | Provider Types: 08, 09, 10, 25, 31, and 52 Effective Oct. 15, 2024, OHCA will require a prior authorization (PA) for ultrasonic bone growth stimulators billed with HCPCS code E0760 (osteogenesis stimulator, low-intensity ultrasound). For SoonerCare members not enrolled in a SoonerSelect plan, authorization will be completed through the provider portal where InterQual criteria will be utilized. For members enrolled in a SoonerSelect plan, providers will need to contact the plan for specific coverage and PA guidelines. As a note, prior authorization is already required for electrical bone growth stimulators and there will be no change to that process. |
| 9/13/24 | Opening Of D2929 For Billing | Provider Type/Specialty: 27/270-279, 08/081 & 086 Effective Aug. 15, 2024, OHCA has opened coverage for D2929 (PREFABRICATED PORCELAIN/CERAMIC CROWN - PRIMARY TOOTH). D2929 is covered for TXIX, HAP and CUST members ages 0-20 with no prior authorization required. Pricing is set at $121.95. Coverage and pricing changes will be added to the online dental fee schedule with the next scheduled quarterly update. |
| 9/12/24 | Q&A Webinar With Our Partners | Provider types: All Message: OHCA is hosting a webinar featuring each partner and their subject matter experts. Please join one or more sessions to ask questions, provide feedback and report issues. • Humana Healthy Horizons in Oklahoma • Oklahoma Complete Health • Aetna Better Health of Oklahoma |
| 9/9/24 | Physician Contract Renewal Reminder | Provider Types: 31 - Physicians We currently have over 18,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, we encourage physicians to submit your renewals as soon as possible. You can log into the provider portal to complete your renewal. Please note that Provider Enrollment does not have access to assist with provider portal issues. If you need assistance, contact our internet helpdesk at 800-522-0114, option 2, then option 1. Or email soonercareinternethelpdesk@gainwelltechnologies.com. This contract is set to expire on Sept. 30, 2024. If you have contract questions, please contact Provider Enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org. |
| 9/4/24 | Psychological/Neuropsychological Testing 96130-96146 | Provider types: 08, 09, 10, 13, 31, and 52 Effective Oct. 1, 2024, OHCA will require a prior authorization for psychological/neuropsychological testing codes 96130-96146, when performed by a medical provider. Prior authorization for this testing is already required for behavioral health providers, and there are no changes to that process. This change is being made in compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) which ensures parity between behavioral health services and medical services. Prior authorization guidelines for medical providers can be found on the OHCA website. |
| 8/30/24 | SoonerSelect health and CSP supplemental payments | Provider Type: 08, 09, 10, 11, 14, 31, 53, and 60 Beginning in September, eligible providers will 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. Providers must meet the following criteria to be eligible for payment under this arrangement:
The initial supplemental payment will be for SoonerSelect paid claims with dates of services between April and June 2024. You may only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced. Subsequent supplemental payments will be made after the end of each quarter. The contracted entities, as directed by OHCA, will distribute these payments. For additional information, please view the Provider Incentive Directed Payment Program guide. |
| 8/29/24 | Long-acting reversible contraceptives (LARC) training | Provider types: 08, 09, 10,13, 16, 31, 52 The Focus Forward Oklahoma Program is working to address issues related to access and utilization of long-acting reversible contraceptives (LARC). There are currently four trainings scheduled: Nov. 9, 2024; Dec. 14, 2024; April 5, 2025; and May 17, 2025. Focus Forward Oklahoma offers no-cost LARC training to Oklahoma providers, clinical support staff and administrative staff. For more information about Focus Forward and available training, visit our Provider Training webpage. |
| 8/28/24 | Long-Term Care Enhanced Payment Update |
ICF/IID Vocational & Day Services Enhanced Payment - Update Run Date: 08/27/2024 – 09/06/2024 PV Type: 03/31,34 The SFY 2025 1st Quarter enhanced payment for vocational and day services will be made on Aug. 28, 2024. We thank you for your continued service to SoonerCare members. |
| 8/28/24 | Long-Term Care PFP Payment Update | Run Date: 8/27/2024 – 9/6/2024 PV Type: 03/30, 35 The SFY 2025 1st Quarter PFP payment will be made on Aug. 28, 2024. We thank you for your continued service to SoonerCare members. |
| 8/26/24 | SFY 2025 Regular Nursing Facility Per Diem Rate Notice | Run Date: 8/21/2024 – 9/13/2024 PV Type: 03/30, 35 The OHCA Board approved SFY 2025 per diem rates for regular nursing facilities on Aug. 12, 2024. The new rates will be retroactive to July 1, 2024. To ensure all services provided in SFY 2025 are paid at the new rates, a payment reconciliation will be completed to account for any underpayments for services provided between July 1-Aug. 13, 2024. The adjustments will be made on Aug. 28, 2024, remittance. Thank you for the services you provide to our long-term care members. If you have any questions, don't hesitate to contact Fred.Mensah@okhca.org. |
| 8/23/24 | D7210 Surgical Extractions | Provider Type/Specialty: 27/270-279, 08/081 & 086 Dental providers must comply with the American Dental Association’s (ADA) Current Dental Terminology (CDT) when billing for surgical extractions, D7210. Providers must clearly document the medical necessity for the surgical extraction, supported by radiographic images and clinical narrative(s) in the patient’s medical record. After review of historical billing practices for D7210 in the SoonerCare program, OHCA observed a history of misapplication and/or erroneous coding practices for this code. Effective June 1, 2024, OHCA approved modified guidelines and changes for both SoonerSelect dental plans, DentaQuest and LIBERTY Dental, as it pertains to D7140 and D7210. Please refer to Provider Letter 2024-11 which outlines the approved modified guidelines in detail. Effective June 1, 2024, the SoonerSelect dental plans began implementing modified prepayment reviews for D7210. If modified prepayment review of D7210 finds insufficient clinical documentation and/or evidence of the need for surgical extraction, the dental plans have OHCA approval to down-code the service to a D7140. OHCA and the SoonerSelect dental plans will continue to monitor billing practices for D7140 and D7210 in both the SoonerSelect dental and the SoonerCare fee-for-service programs. Providers who consistently demonstrate a pattern of misapplication of these CDT codes may be subject to recoupments and/or referral(s) for investigation into fraud, waste and abuse. |
| 8/21/24 | Denture Adjustments, Tissue Conditioners and Relines | Provider Types: 27/270-279, 08/081 & 086 Concerning dentures, adjustments, tissue conditioners and relines, OHCA protocol states a provider is responsible for denture maintenance and feasibility for 24 months (2 years) from delivery. The provider must deliver a prosthesis that is reasonably functional and esthetically presentable. Any adjustments or additions (e.g., tissue conditioners) associated with the initial delivery and within 24 hours of delivery are included in the initial reimbursement and are not separately billable. All adjustments and/or tissue conditioners done on same date of delivery cannot be charged separately and are all included in the denture fee. Separate billing is allowed for adjustments (using appropriate CDT codes D5410, D5411, D5421 or D5422) performed after the delivery of the prosthetic up to 3 times per arch per 12 months. Additionally, separate billing is allowed for tissue conditioner (using appropriate CDT codes D5850 or D5851) if documentation supports the service is medically necessary for healing, tissue changes or to facilitate proper fit and function. Adjustments associated with tissue conditioners and/or hard relines on the date of service are included in the fee for the tissue conditioner or reline and are not reimbursable. Six months following the initial delivery of the prothesis, the member may be eligible for a hard reline if supported by documentation and medically (clinically) necessary. |
| 8/19/24 | SFY 2025 Regular Nursing Facility Per Diem Rate Notice | PV Type: 03/30, 35 The Oklahoma Health Care Authority Board approved SFY 2025 per diem rates for regular nursing facilities on Aug. 12, 2024. The new rates will be retroactive to July 1, 2024. To ensure all services provided in SFY 2025 are paid at the new rates, a payment reconciliation will be completed to account for any underpayments for services provided between July 1-Aug. 13, 2024. Reconciliation payments will be made to providers as soon as possible. The payment date will be communicated to providers by the end of August 2024. Thank you for the services you provide to our long-term care members. If you have any questions, don't hesitate to contact Fred.Mensah@okhca.org. |
| 8/19/24 | Caries Risk Assessments | Provider Types: 27/270-279, 08/081 & 086 This guidance pertains to coverage of caries risk assessment (CRAs) codes D0601, D0602 and D0603. The dental provider’s evaluation of each individual member’s caries risk will determine the correct D code to submit for reimbursement, depending upon whether the member is found to be low, moderate or high risk. A completed CRA may be reimbursed once per member per year. Per OHCA policy, a member must be caries-free for the previous 12 months before they can be referred to an orthodontist for an orthodontic evaluation. OHCA strongly recommends CRAs be completed regularly by the member’s primary care dentist (PCD) and maintained within the member’s chart. A completed CRA should be included in referral paperwork for orthodontic evaluations. If you are a SoonerSelect participating provider, the proper application and billing of CRA codes can help maximize access to value-added benefits available exclusively through the contracted SoonerSelect Dental plans. For questions about the SoonerSelect dental program, please refer to the member’s dental plan, DentaQuest and/or LIBERTY Dental, using the contact information available online at SoonerSelect Provider Resources. |
| 8/15/24 | ELECTRONIC SUBMITTERS/RECEIVERS: Upcoming EDI Translator Changes | Provider types/specialties: All ATTENTION EDI SUBMITTERS, TRADING PARTNERS, SOFTWARE VENDORS AND PROVIDERS: OHCA moved to a new translator on July 15, 2024. Some of the changes you will notice are outlined below; please make any corresponding updates to your system as needed. If you have any questions, contact the EDI helpdesk at 800-522-0114, option 2, 2.
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| 8/12/24 | Provider Portal Unlock for Physician Renewals | Provider Type: 31 To ease the renewal experience for physicians, OHCA has unlocked Provider Portal accounts for those providers who will expire on Sept. 30, 2024, or were locked out of their individual portals due to inactivity. If you do not remember your login information, reach out to our helpdesk at 800-522-0114, option 2, then option 1. Or email SoonerCareInternetHelpdesk@gainwelltechnologies.com. Please be sure to log into your portal and start the renewal process prior to Sept. 30, 2024 to prevent coverage gaps. |
| 8/5/24 | Coverage for 58674 – Acessa | Provider Types: 01, 08, 09, 10, 31, and 52 Effective Aug. 1, 2024, OHCA will cover CPT 58674 - DESTRUCTION OF GROWTH OF UTERUS USING AN ENDOSCOPE WITH ULTRASOUND GUIDANCE AND MONITORING (Acessa procedure) for treatment of uterine fibroids. Coverage will be for ages 10-60 and no prior authorization will be required. |
| 7/23/24 | Needs assessment for school-based services in a school setting | Provider Types: 07, 08, 09, 10, 11, 12, 13, 16, 17, 18, 19, 20, 21, 23, 31, 36, 52, 53 Please complete the school-based services needs assessment survey by July 30, 2024. This survey is from the Oklahoma State Department of Education and the Oklahoma Health Care Authority for school-based Medicaid services. School-based Medicaid services are currently pursuant to an Individual Education Plan (IEP) in the state of Oklahoma. School-based Medicaid services do not limit access to health services in the community; instead, they complement community health resources by providing additional care and support to eligible students directly within the school environment. Email Kellie Carter, program manager for school health at the Oklahoma State Department of Education, for questions, comments or concerns at kellie.carter@sde.ok.gov, or Lana Brown, school-based services manager at the Oklahoma Health Care Authority at lana.brown@okcha.org. This survey is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2.5 million with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of nor an endorsement by CMS/HHS or the U.S. government. |
| 7/8/24 | Taxonomy Assignments Webinar | Provider Types: All Join us for an overview of OHCA’s taxonomy assignment process with our SoonerSelect health plan partners Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma and Oklahoma Complete Health. Register for the morning session at 10 a.m. on Wednesday, July 17, 2024. Register for the afternoon session at 2 p.m. on Wednesday, July 17, 2024. |
| 7/8/24 | Long Term Care (LTC) Cost Report | SFY 2024 Cost Report Run Date: 07/01/2024 – 10/31/2024 PV Type: 03/30, 31, 34, 35 This is a reminder to long-term care providers that all cost reports for the State Fiscal Year ending June 30, 2024, will be due on or before Oct. 31, 2024. You must report costs electronically via the OHCA provider portal, unless you are submitting a partial year cost report. All partial year cost reports must be submitted using the Data Entry File for Partial Year Reporting form. If a change of ownership has occurred and you have an entire year of data available, then the two partial reports must be combined and entered in the provider portal. New Update for ICF/IID Facilities Participating in the Enhanced Payment for Vocational and Day Services Program: The expenses for vocational and/or day services previously reported on the “office expense” schedule will now be reported in “general expenses.” Please make sure you report all costs for activities or items directly traceable to vocational and/or day services (excluding staffing and overhead) on the general expenses schedule. You will enter the total amount of these expenses in the fields titled: Vocational Services Cost (ICF ONLY), and/or Day Services Cost (ICF ONLY). In addition, we are entering our second year of the Enhanced Payment for Vocational and Day Services Program. This means, starting in SFY 26, the calculations pertaining to the Direct Cost Component of the rate, will be calculated using relative direct day services cost and relative direct vocational services costs reported by each facility, on the most recent annual cost report. ICF/IID providers participating in the Enhanced Payment for Vocational and Day Services Program will be required to report all program expenses on the current year’s cost report. Failure to report vocational and/or day services costs could adversely impact payment under the Enhanced Payment for Vocational and Day Services Program. Thank you for the services you provide to SoonerCare members. |
| 6/26/24 | CMS Annual Rate Adjustment | Provider types/specialties: 08/087, 182, & 17/145, 170-175, 179 To help you prepare for the Centers for Medicare and Medicaid Services’ annual rate adjustment period, OHCA released an advanced notice of rate changes for billing codes. The updated rates for CPT codes, which are used by multiple provider types, will be effective July 1, 2024. The majority of OHCA's fee schedule is based on CMS's fee schedule, and CMS adjusts its rate every year. This adjustment happens outside of any program changes Oklahoma has completed during the current year or any future year. CMS rates are connected to a conversion factor, which is adjusted annually. However, CMS uses other variables to calculate the rate for each code. These include things such as work time, malpractice and practice expense. They are all multiplied by the conversion factor to calculate the rate for each code. These additional factors mean that the amount individual codes change varies from one code to the next. We provide advance notice to ensure you have adequate time to update your billing systems and integrated software in preparation for the updated rates. SoonerSelect contracted entities are required to reimburse in-network providers no less than 100% of the OHCA fee schedule through July 1, 2026. These fee schedule changes, though not initiated by the contracted entities, will be used by the contracted entities beginning July 1, 2024, to align with OHCA’s fee schedule. You can learn more about the federal rate-setting process on the CMS website. |
| 6/26/24 | Modifier 95 – Telehealth | Providers: All Effective July 1, 2024, OHCA will add modifier 95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications systems) as an allowed modifier to report services delivered via telehealth. More information about telehealth and services allowed to be delivered via telehealth can be found on the provider telehealth page. |
| 6/20/24 | C-Section Rate Letters | PV Types: 01, 08, 31, 52 C-section rate letters for the first six months (July–December) of state fiscal year 2024 are available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically. If you need help retrieving your letters, please call 800-522-0114. You may also view the SoonerCare C-section rates and reports available at OHCA’s Cesarean Reports page. Thank you. |
| 6/13/24 | 2024 Under Supervision Provider Renewals | Provider type/Specialties: 53/536 OHCA is aware of an issue that is preventing certain behavioral health agency types from being reflected in the system as an eligible option for provider types currently renewing or submitting new applications. To preserve the ability to renew for currently enrolled providers, we need to identify specific providers currently affected by this issue. If you are a currently an under-supervision candidate attempting to renew, and have not been able to complete the renewal because one or more agencies of employment are not available as eligible service locations, please email ProviderEnrollment@okhca.org as soon as possible. Include your Provider ID number and current application tracking number (ATN) if available. |
| 5/30/24 | Long-Term Care PFP Payment Update | Nursing Facility Pay for Performance (PFP) Payment Update Run Date: 5/27/2024 – 6/7/2024 PV Type: 03/30, 35 SFY 2024 4th Quarter PFP payment will be made on May 29, 2024. We thank you for your continued service to SoonerCare members. |
| 5/30/24 | Long-Term Care Enhanced Payment Update |
ICF/IID Vocational & Day Services Enhanced Payment - Update Run Date: 05/27/2024 – 06/07/2024 PV Type: 03/ 31,34 SFY 2024 4th Quarter enhanced payment for vocational and day services will be made on May 29, 2024. We thank you for your continued service to SoonerCare members. |
| 5/30/24 | NB-1 Processing | Provider types/ specialties: All OHCA has identified that our system is not backdating the effective dates of health and dental plans to the dates of birth of deemed newborns. A newborn is considered deemed only when the mother was on SoonerCare at the time of the baby’s birth. The system work to correct this is anticipated to take up to 10 months or more. In the meantime, our eligibility team will be manually backdating the plan effective dates to the date of birth of the deemed newborn when possible. We are currently working through a list of newborns born between April 1-May 17, 2024, and anticipate completion of this list by June 20, 2024. Starting May 27, we will be working through a weekly list of newborns who have dates of births from the week prior. Please allow at least two weeks for the necessary updates to be made to the newborns’ plans. You may still add newborns via the eNB1 process as those babies will show on our report to correct their plan effective date. You may also add newborns via the NB-1 process by using the NB-1 form and emailing it to NODOS-NB1@okhca.org. Please use the provider portal to check the status of a newborn’s plan enrollment. If you have questions regarding a newborn’s plan effective date, please email NODOS-NB1@okhca.org. |
| 5/30/24 | Bathroom Equipment Prior Authorization | Provider types/ specialties: 01, 08, 09, 10, 25, 31, and 52 Effective June 1, 2024, OHCA will require prior authorization for bathroom equipment codes E0244 (raised toilet seat), E0245 (tub stool or bench), E0247 (transfer bench) and E0248 (transfer bench, heavy duty). These items are manually priced and per OHCA policy 311: 30-5-211.3, all manually priced DME items require a prior authorization. Guidelines for these items can be found on the Durable Medical Equipment page. |
| 5/29/24 | SoonerSelect In-Person Office Hours in Tulsa | Provider types/specialties: All Representatives from the SoonerSelect health plans and the Children's Specialty Program will be at the Owasso Conference Center from noon-4 p.m., Thursday, May 30. This is a chance to have your SoonerSelect questions answered in person, so make plans to stop by and talk directly with a plan representative from Aetna Better Health, Humana Healthy Horizons or Oklahoma Complete Health. Each of the plans continues to hold virtual office hours as well. Visit the provider resources page for a listing of hours and links. |
| 5/9/24 | Policy Compliance Reminder | Provider types/specialties: All The General Agreement between a provider and the Oklahoma Health Care Authority, Article IV, Scope of Work states: “Unless otherwise specified in the Special Provisions for provider’s type, Provider agrees to the following: (f) To comply with all applicable statutes, regulations, policies, and properly promulgated rules of OHCA.” All policies and rules can be found on OHCA’s public website at the following link: Policy and Rules (oklahoma.gov). Claims not compliant with OHCA policy are identified as payment errors and subject to recoupment during an audit. The OHCA would like to highlight three recurrent issues being identified and the applicable policy.
Contracted Provider: O.A.C. 317:30-3-2 states: “In order to be eligible for payment, providers must have on file with OHCA, an approved Provider Agreement.” Rendering Provider on Claim: O.A.C. 317:30-3-1(b) states: “Payment to practitioners under Medicaid is made for services clearly identifiable as personally rendered services performed on behalf of a specific member. There are no exceptions to personally rendered services unless specifically set out in coverage guidelines.” O.A.C. 317:30-5-1(1) states: “Payment to physicians under SoonerCare is made for services clearly identifiable as personally rendered services performed on behalf of a specific patient. There are no exceptions to personally rendered services unless specifically set out in coverage guidelines.” Record Authentication: O.A.C. 317:30-3-4.1(1)(E) states: “The authentication of an electronic medical record (signature and date entry) is expected on the day the record is completed. If the electronic medical record is transcribed by someone other than the provider, the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed. Before any claim is submitted to OHCA for payment of a provided service, the provider must authenticate the electronic medical records relating to that service.” O.A.C. 317:30-3-30(b) states: “A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance, or obligation. The authentication of a medical record (signature and date entry) is expected on the day the record is completed. If the medical record is transcribed by someone other than the provider, the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed. Before any claim is submitted to OHCA for payment of a provided service, the provider must authenticate the medical records relating to that service.” |
| 5/3/24 | Genetic Testing – Human Platelet Antigen Genotyping | Provider Types/Specialties: 01/08/09/10/28/31/52 Effective May 1, 2024, OHCA is adding coverage for human platelet antigen genotyping codes 81105-81112. These services will be covered for ages 0-999 and will require a prior authorization (PA). The Genetic Molecular Pathology guidelines have been updated to include the criteria for this new coverage. |
| 5/2/24 | PCP/PCMH | Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 Dear SoonerSelect Provider, During the SoonerSelect transition on April 1, 2024, members were assigned a primary care provider by their assigned/chosen health plan. Several factors were considered during this assignment process including historical PCP assignment information provided by OHCA, distance to provider from the member’s address and provider network status with the contracted entity. We understand that this may have caused disruption to your PCP panel assignments that you were accustomed to under SoonerCare Choice. In order to reduce disruption in care for SoonerSelect members, each of the contracted entities will be reassigning members, to the extent possible, back to their pre-implementation PCP unless a member has actively chosen a new PCP. Information regarding specific assignment information will be forthcoming from each of the SoonerSelect contracted entities. Reassignments are expected to take place over the next 7-10 days. |
| 5/1/24 | Updated Coverage Guidelines for Molecular Diagnostic Testing for Infectious Diseases | Provider types: 01, 08, 09, 10, 14, 28, 31, 52 Effective April 24, 2024, OHCA has updated coverage guidelines for Molecular Diagnostic Testing for Infectious Diseases. The latest guideline includes grammar and proofreading changes; there were no changes in coverage criteria. |
| 4/25/24 | SoonerSelect Vision Benefits Webinar Featuring Our SoonerSelect Partners | Provider Types: 18 Optometrist/180 Optometrist, 19 Optician/190 Optician, 207 ITU Optician, 31 Physician/330 Ophthalmologist, 543 Pediatric Ophthalmology, 52 State Employed Physicians/330 Ophthalmologist, 543 Pediatric Ophthalmology Description: Join us for an overview of vision benefits and vision services provided by our SoonerSelect partners. Register for the session with Aetna Better Health of Oklahoma at noon, Tuesday, May 7, 2024. Register for the session with Humana Healthy Horizons in Oklahoma at noon, Wednesday, May 8, 2024. Register for the session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at noon, Thursday, May 9, 2024. |
| 4/23/24 | Human Immunodeficiency Virus (HIV) Counseling, CPT code 99401 is available for use | Provider types/specialties: 081, 084, 088, 185, 199, 090, 092, 093, 100, 130, 316, 318, 320, 322, 328, 344, 345, 349, 359, 316, 318, 320, 328, 344, 345, 349, 359 Oklahoma is one of seven states identified in the 2019 End HIV Initiative that has a statistically disproportionate occurrence of HIV in rural areas. To increase awareness and incentivize providers to have crucial conversations with members surrounding HIV awareness and prevention, the Oklahoma Health Care Authority has approved the use of CPT code 99401 for HIV counseling. CPT code 99401 is available for use:
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| 4/22/24 | File Updates | Provider Types: All Please update your OHCA provider files to ensure all details, including new or missing locations and group member assignments, are accurate. If your update impacts services under SoonerSelect partners, please email your Application Tracking Number (ATN), received upon submitting your update on the OHCA provider portal, to providerenrollment@okhca.org with "SoonerSelect update" and your Application Tracking Number in the subject line. |
| 4/18/24 | Long-Acting Reversible Contraceptives (LARC) Training | Provider types: 08, 09, 10,13, 16, 31, 52 The Focus Forward Oklahoma program works to address issues related to access and utilization of long-acting reversible contraceptives (LARC). No-cost LARC training is available to Oklahoma providers, clinical support staff and administrative staff. There are currently two trainings available on June 22, 2024 and June 29, 2024. For more information about Focus Forward and available training, visit our provider training web page or view the flyer with additional details and registration code. |
| 4/5/24 | Long-Acting Reversible Contraceptives (LARC) Training | Provider types: 08, 09, 10,13, 16, 31, 52 The Focus Forward Oklahoma program works to address issues related to access and utilization of long-acting reversible contraceptives (LARC). No-cost LARC training is available to Oklahoma providers, clinical support staff and administrative staff. There is currently one training scheduled in April 2024. For more information about Focus Forward and available training, visit our Provider Training web page. |
| 3/29/24 | SoonerSelect Webinar Featuring Our Partner Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program | Provider Types: All Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim. Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types. Behavioral Health Providers Click here to register for the Behavioral Health session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 9 a.m. on Thursday, April 11, 2024. Click here to register for the Behavioral Health session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 2:30 p.m. on Tuesday, April 16, 2024. PT/OT/ST Click here to register for the PT/OT/ST webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 11:30 a.m. on Thursday, April 11, 2024. Click here to register for the PT/OT/ST webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 9 a.m. on Tuesday, April 16, 2024. All other providers Click here to register for all other providers' webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 2:30 p.m. on Thursday, April 11, 2024. Click here to register for all other providers' webinar session with Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program at 11:30 a.m. on Tuesday, April 16, 2024. |
| 3/29/24 | SoonerSelect Webinar Featuring Our Partner Humana Healthy Horizons in Oklahoma | Provider Types: All Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim. Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types. Behavioral Health Providers Click here to register for the Behavioral Health session with Humana Healthy Horizons in Oklahoma at 9 a.m. on Wednesday, April 10, 2024. Click here to register for the Behavioral Health session with Humana Healthy Horizons in Oklahoma at 2:30 p.m. on Thursday, April 18, 2024. PT/OT/ST Click here to register for the PT/OT/ST webinar session with Humana Healthy Horizons in Oklahoma at 11:30 a.m. on Wednesday, April 10, 2024. Click here to register for the PT/OT/ST webinar session with Humana Healthy Horizons in Oklahoma at 9 a.m. on Thursday, April 18, 2024. All other providers Click here to register for all other providers' webinar session with Humana Healthy Horizons in Oklahoma at 2:30 p.m. on Wednesday, April 10, 2024. Click here to register for all other providers' webinar session with Humana Healthy Horizons in Oklahoma at 11:30 a.m. on Thursday, April 18, 2024. |
| 3/29/24 | SoonerSelect Webinars Featuring Our Partner Aetna Better Health of Oklahoma | Provider Types: All Topics will include but are not limited to an overview of Availity, how to file a prior authorization, and how to file a claim. Please note that there two are separate opportunities to hear from each CE for Behavioral Health Providers, PT/OT/ST providers and all other provider types. Behavioral Health Providers Click here to register for the Behavioral Health session with Aetna Better Health of Oklahoma at 9 a.m. on Tuesday, April 9, 2024. Click here to register for the Behavioral Health session with Aetna Better Health of Oklahoma at 2:30 p.m. on Wednesday, April 17, 2024. PT/OT/ST Click here to register for the PT/OT/ST webinar session with Aetna Better Health of Oklahoma at 11:30 a.m. on Tuesday, April 9, 2024. Click here to register for the PT/OT/ST webinar session with Aetna Better Health of Oklahoma at 9 a.m. on Wednesday, April 17, 2024. All other providers Click here to register for all other providers' webinar session with Aetna Better Health of Oklahoma at 2:30 p.m. on Tuesday, April 9, 2024. Click here to register for all other providers' webinar session with Aetna Better Health of Oklahoma at 11:30 a.m. on Wednesday, April 17, 2024. |
| 3/29/24 | SoonerSelect Eligibility Verification | Provider Types: All Exciting news! If a member is enrolled in the SoonerSelect dental program (SoonerDental), you are now able to verify in which plan the member is enrolled. Click on the + (plus) sign in the Managed Care section of the eligibility screen and it will expand to show you the member’s plan name. Please note: |
| 3/29/24 | PCMH Care Coordination Payments | Provider Types: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 OHCA made the last PCMH care coordination payment for members transitioning to SoonerSelect on Feb. 28, 2024. The February 2024 payment is a prospective payment for March 2024. Beginning April 2024, the contracted entities (CE) will make the PCMH care coordination payments for SoonerSelect members. Each CE will have a PCMH payment calendar; please see below for additional information regarding PCMH payments per plan.
OHCA will continue to make PCMH care coordination payments for members who are not enrolled in SoonerSelect but who are still eligible to receive services through SoonerCare PCMH. Please make sure you have submitted your EFT info to the plans. |
| 3/29/24 | SoonerSelect Health Plans and SoonerSelect Children’s Specialty Program begin April 1, 2024 | Provider types: All Providers OHCA encourages all health care providers to contract with each SoonerSelect health plan — Aetna Better Health of Oklahoma, Humana Healthy Horizons in Oklahoma, Oklahoma Complete Health, and Oklahoma Complete Health for the Children’s Specialty Program — to continue serving all SoonerCare members who have transitioned to SoonerSelect. Contact the health plans for more information on provider contracting. Visit the SoonerSelect page for contact information, provider directories, benefit guides and member handbooks. More materials include day one guides, FAQs and other resources that will help you continue to serve members. |
| 3/15/24 | Important Information Regarding Prior Authorizations and Billing for SoonerCare Behavioral Health Providers Contracted and NOT Contracted with ODMHSAS | Provider types: 017, 110, 111, 112,114, 115, 116, 118, 121, 134, 135, 136, 137,138 Message: Effective April 1, 2024, due to the transition to SoonerSelect, there will be some important changes to prior authorizations and requirements for completion of the Customer Data Core (CDC). SoonerSelect DMH Contracted and Non-Contracted Providers.pdf (oklahoma.gov) |
| 3/5/24 | SoonerSelect Dental Webinars Featuring Our Partners DentaQuest and LIBERTY Dental | Provider Types: 27/270-279, 08/081 & 086 Don’t miss this amazing opportunity to hear from our partners DentaQuest and LIBERTY Dental. There is still space available; register using the links below. Topics will include but are not limited to continuity of care period, prior authorizations, contracting/credentialing and dental home. Click here to register for the LIBERTY Dental session at 2 p.m., Tuesday, March 5, 2024. Click here to register for the LIBERTY Dental session at 10 a.m., Thursday, March 7, 2024. Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024. Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024. Click here to register for the LIBERTY Dental session at 2 p.m., Wednesday, March 13, 2024. |
| 3/5/24 | Psychiatric Collaborative Care and Behavioral Health Integration Services | Provider Types: 08, 09, 10, 31, and 52 Effective Nov. 1, 2023, OHCA has added coverage for psychiatric collaborative care and behavioral health integration services. Coverage and billing information for these services can be found here. |
| 3/4/24 | SoonerSelect Provider Information Requests | Provider Types: All OHCA has been working with our SoonerSelect partners to ensure they have an adequate network to serve our SoonerCare members. The health plans may need additional information from our provider community to complete provider files and update provider directories. OHCA is aware of these requests and asks that you work with the health plans by sharing the additional requested information to ensure they have complete and accurate provider information for our members. |
| 3/1/24 | SoonerSelect Dental Webinar Cancelation | Provider Types: 27/270-279, 08/081 & 086 Description: Due to unforeseen circumstances the SoonerSelect dental webinar with DentaQuest that was scheduled for 10 a.m., Tuesday, March 5, has been canceled. Please remove this webinar from your calendar and sign up for one of the remaining sessions. Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024 Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024 |
| 3/1/24 | Long-Term Care PFP Payment Update |
TITLE: Nursing Facility Pay for Performance (PFP) Payment Update Run Date: 2/26/2024 – 3/8/2024 PV Type: 03/ 30,35 SFY 2024 3rd quarter PFP payment will be made on Feb. 28, 2024. We thank you for your continued service to SoonerCare members. |
| 3/1/24 | Long-Term Care Enhanced Payment Update | TITLE: ICF/IID Vocational & Day Services Enhanced Payment -Update Run Date: 02/26/2024 – 03/08/2024 PV Type: 03/ 31,34 SFY 2024 3rd quarter enhanced payment for vocational and day services will be made on Feb. 28, 2024. We thank you for your continued service to SoonerCare members. |
| 3/1/24 | Licensed Behavioral Health Renewals 2024 | Provider Types/Specialties: 093, 115, 121, 535, 585, 586, 587 Providers: This is a reminder that licensed behavioral health provider contracts (type 53 including LADC, LMFT, LPC, LBHP and LCSW) are set to expire Feb. 28, 2024. Contracts that have not had a renewal completed by Feb. 29, 2024, will be unable to submit claims until their renewal has been submitted and approved. OHCA will be unable to prioritize renewals for any provider submitted after Feb. 28, 2024, and all renewals will be processed based on the date received. Failure to complete a renewal will result in the provider being required to submit a new application to become credentialed with SoonerCare. |
| 2/26/24 | SoonerSelect Dental Webinars Featuring Our Partners DentaQuest and LIBERTY Dental | Provider Types: 27/270-279, 08/081 & 086 Description: Please join us for one or more sessions presented separately by our dental partners, DentaQuest and LIBERTY Dental. Topics will include but are not limited to continuity of care period, prior authorizations, contracting/credentialing and dental home. Click here to register for the LIBERTY Dental session at 2 p.m., Tuesday, March 5, 2024 Click here to register for the LIBERTY Dental session at 10 a.m., Thursday, March 7, 2024 Click here to register for the DentaQuest session at 2 p.m., Thursday, March 7, 2024 Click here to register for the DentaQuest session at 10 a.m., Wednesday, March 13, 2024 Click here to register for the LIBERTY Dental session at 2 p.m., Wednesday, March 13, 2024 |
| 2/20/24 | Request for Coverage Consideration | Providers: All Providers and vendors may request consideration for SoonerCare coverage of a new service, procedure, technology, device or other benefit. For your request to be considered, please complete and submit a Request for New SoonerCare Coverage Consideration Form. Remember to attach any requested supporting documents and any other evidence-based documents you wish to be considered in this review of coverage to the completed form. Completed forms should be submitted by email to massunit@okhca.org. Investigational, non-FDA approved, experimental or solely cosmetic services will not be considered for coverage. All services must be medically necessary in accordance with OAC 317:30-3-1(f). |
| 2/20/24 | Medical and DME Retro PA Requests | Provider Type – All Medical and Durable Medical Equipment Providers 01/010, 012, 014,- 018, 201, 206, 02/020 - 022, 06/060, 08/080 -082, 084, 085, 088, 106, 181, 183, - 186, 188, 192, 194 -199, 202, 203, 208, 801, 802, 09/90-96, 210, 211, 564, 999 10/100-102, 14/140, 18/180, 19/190, 207 22/220, 25/220, 250-253, 277, 28/280-281, 29/290-292, 31/272, 310-338, 340-352, 354-359, 520-529, 540-552, 554-566, 568, 569, 999 In response to feedback from medical and durable medical equipment (DME) providers about the practical challenges that cessation of retroactive prior authorization (PA) requests causes, OHCA is changing its requirements. OHCA will allow retro PA requests to be submitted up to five business days after the first service date. Please limit your submissions to retro requests of no more than five business days after the first date of service. Requests beyond the five days will be canceled. Medical imaging retro PA requests will remain at three business days. |
| 2/20/24 | Dental Retro PA Requests | Provider Type – All Dental Providers 021, 086, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 999 In response to feedback from dental providers about the practical challenges that cessation of retroactive prior authorization (PA) requests causes, OHCA is changing its requirements. OHCA will allow retro PA requests to be submitted up to five business days after the first service date. Please limit your submissions to retro requests of no more than five business days after the first date of service. Requests beyond the five days will be canceled. |
| 2/8/24 | C-Section Rate Letters | PV Types: 01, 08, 31, 52 The year-end C-section rate letters for state fiscal year 2023 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 SoonerCare C-section rates and reports available on the Cesarean Reports webpage. Thank you. |
| 2/1/24 | SoonerSelect Dental – Getting Started and Preparedness for Day One Webinar | Provider Types: 27/270-279, 08/080-081 & 086 This class will provide you with the tools you need to be successful during the transition and implementation of the SoonerSelect Dental Program. Join us at 10-11 a.m., Thursday, Feb. 8, 2024. Click here to register. |
| 1/30/24 | SoonerSelect and School-Based Services pursuant to an IEP or IFSP | Provider Type: 12/120 Targeted Audience: OHCA-contracted school districts and OHCA providers that provide Medicaid services pursuant to an IEP or IFSP. OHCA is delaying including school-based and SoonerStart program services in SoonerSelect for the first 15 months from the date of SoonerSelect implementation (April 1, 2024). Through the 15-month extension, school-based and SoonerStart services will be processed and reimbursed through OHCA, maintaining current reimbursement practices. Health and Children’s Specialty Program CEs will reimburse OHCA-enrolled qualified school providers and SoonerStart providers beginning July 1, 2025. If you have any questions regarding this global, please email Lana.Brown@okhca.org. |
| 1/25/24 | Dental CRNA Coding and Services | Provider Types: 27/270-279, 08/080-081 & 086 09/94 All dental providers using CRNA services and/or billing for in-office sedation, other than nitrous oxide, should review the terms and conditions for billing and coding to ensure that you are in compliance with federal regulations, state policies and other guidelines. We strongly encourage a review of your contract language to ensure your coding and billing practices are compliant with documentations standards, policy and other applicable regulations. CRNA services must be billed with the actual servicing provider listed as the rendering provider on the claim, and all rendering providers must have a contract with OHCA (O.A.C. 317:30-3-1(b)). OHCA will soon be providing additional education and clarity on this subject. Until then, please review your coding and practices and align them with required practices and policy. |
| 1/25/24 | SoonerSelect Dental- Getting Started and Preparedness for Day One Webinar | Provider Types: 27/270-279, 08/080-081 & 086 This class will provide you with the tools you need to be successful during the transition and implementation of the SoonerSelect Dental Program. Jan 30, 2024, 10:00-11:30 AM. Click here to register. |
| 1/25/24 | SoonerPlan FPL Threshold | Provider Types/Specialties: All The Oklahoma Health Care Authority has raised the FPL threshold for the SoonerPlan program. View the new income guidelines on the OHCA website. This change will expand access to reproductive health services for individuals ages 19 and older who are uninsured or underinsured and do not qualify for these services through other SoonerCare programs. The goals are to improve outcomes across the State in:
The effective date for the new income guidelines is Jan. 1, 2024. |
| 1/25/24 | Quarterly Orthodontic Payments | Provider Types: 27/270-279, 08/080-081 & 086 Effective Feb. 1, 2024, the orthodontic payment structure will change from three yearly bulk payments over a 36-month period to one yearly bulk payment and four quarterly payments over a 24-month period. Dental providers can review information regarding this change by visiting our Provider Training page and viewing the Quarterly Orthodontic Payments document found under Resources. |
| 1/24/24 | SoonerSelect Dental Eligibility Verification | Provider Type: Dentists 27, 270-279, 08, 080, 081, 086 This is to inform you that the SoonerCare Provider Portal will be able to show if a member is enrolled in the SoonerSelect Dental Program; however, it will not show the dental plan assignment until or after 2/15/2024. Follow the steps below to check member SoonerSelect Dental Program eligibility and identify plan assignment until the Provider Portal is updated. 1. Verify eligibility on OHCA secure provider portal; look for SoonerDental, if not listed, the member remains on traditional SoonerCare so you may continue as usual; if SoonerDental is returned in your results, please continue to Step 2. 2. Verify eligibility with the member’s plan, LIBERTY LIBERTY Dental Plan of Oklahoma or DentaQuest www.DentaQuest.com via their provider portal. If unable to determine which plan the member is assigned to, ask the member for their ID card, and proceed with contacting their plan. 3. If you are unable to determine eligibility, please call the Provider Helpline at 1-800-522-0114, Option 1 for assistance. We have an upcoming training for dental provider’s and their staff on January 30, 2024, at 10:00 am., titled “SoonerSelect Dental – Getting Started and Preparedness for Day One”. You may register for training here. We look forward to sharing important information about our SoonerSelect Dental program. |
| 1/11/24 | Medical and DME Retro Prior Authorizations | Provider Type: All Medical Providers and All Durable Medical Equipment Providers 01/010, 012, 014,- 018, 201, 206, 02/020 - 022, 06/060, 08/080 -082, 084, 085, 088, 106, 181, 183, - 186, 188, 192, 194 -199, 202, 203, 208, 801, 802, 09/90-96, 210, 211, 564, 999 10/100-102, 14/140, 18/180, 19/190, 207 22/220, 25/220, 250-253, 277, 28/280-281, 29/290-292, 31/272, 310-338, 340-352, 354-359, 520-529, 540-552, 554-566, 568, 569, 999 Effective Feb. 1, 2024, OHCA will no longer issue retroactive authorizations for medical services or durable medical equipment (DME). This change applies specifically to prior authorizations submitted via the secure provider portal utilizing the medical radio button. Authorization processes currently in place for behavioral health services are not included in this change. Please submit any outstanding authorization requests (that fall within the currently allowed retroactive date timeframe) for retroactive authorizations no later than close of business on Jan. 31, 2024. A complete request must be submitted by close of business Jan. 31, 2024 to avoid cancellation. |
| 1/10/24 | Dental Retro Prior Authorizations | Provider Type: All Dental Providers 021, 086, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 999 Effective Jan. 27, 2024, dental services will no longer be authorized retroactively. Services that require a prior authorization must be requested and approved prior to rendering. All requests for outstanding retroactive dental services must have a complete request submitted by close of business Jan. 26, 2024, to avoid cancellation. |
| 1/9/24 | Oklahoma Health Information Exchange (HIE) Updates webinar | The Office of the State Coordinator for Health Information Exchange (HIE) and State-Designated Entity, MyHealth Access Network, invite participants to a virtual speaking engagement. The webinar will provide an overview of the purpose, framework and coverage of the HIE, the approved emergency rules surrounding broad based exemptions, connection fee assistance, and provider incentive directed payments for those who connect and utilize the HIE. These directed payment incentives can result in a significant reimbursement increase for the provider types listed below. Providers eligible for the directed payments include advanced practice nurses, mid-level practitioners, mental health providers and licensed behavioral health practitioners1, podiatrists, physicians2, and anesthesiologist assistants. Click here to register for the Oklahoma Health Information Exchange (HIE) Updates webinar from 11 a.m.-12:30 p.m., Wednesday, Jan. 24, 2024. 1Behavioral health services by mental health professionals and licensed behavioral health practitioners at community mental health centers are excluded as they participate in a separate directed payment program. 2Services rendered by state employed or contracted physicians are excluded as they participate in a separate directed payment program. Provider Type/Specialty: All |
| 1/5/24 | Quality Improvement Fluoride Varnish (QIFV) Project Webinar | Provider Types/Specialties: Primary care and pediatric providers doing well-child checks The Oklahoma Health Care Authority is presenting a webinar for SoonerCare providers on Tuesday, Jan. 16. The Quality Improvement Fluoride Varnish (QIFV) project is aimed at increasing the use of fluoride varnish for children in medical clinics, decreasing the incidence of dental caries in SoonerCare children, and improving the overall health of SoonerCare kids. Visit the OHCA Provider Training page to register to attend the QIFV webinar from 2-3:30 p.m., Tuesday, Jan. 16. After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify SoonerCareEducation@okhca.org to cancel their registration. |
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