Global Messages

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 four upcoming trainings

 scheduled: Saturday, April 5 (Tulsa); Saturday, May 17 (OKC); Saturday, June 21 (Tulsa); and Saturday, June 28 (OKC).

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 OHCA’s Provider Training page.

Providers: All

Oklahoma Medicaid enrolled clinicians may request consideration for SoonerCare coverage or expanded coverage of a new service, procedure, technology, device or other benefit. For the request to be considered, please complete and submit a Request for New SoonerCare Coverage Consideration Form found on the OHCA website. Remember to attach any requested supporting documents and any other evidence-based documents you wish to be considered to the completed form.

Services that are investigational, non-FDA approved, experimental or solely cosmetic will not be considered for coverage. All services must be medically necessary in accordance with OAC 317:30-3-1(f).

We do not review requests from vendors or manufacturers without a specific clinician with a specific medical need for a specific member or member group. 

Provider types: 01, 08, 09, 10, 52

Message:  Please join OHCA and our three SoonerSelect partners at 10 a.m., April 1, 2025, for an overview of SBIRT (Screening, Brief Intervention and Referral to Treatment), which is a comprehensive and integrated public health approach to the delivery of early intervention and treatment services. The webinar will include information about the incentive program and guidelines for documentation. It will also provide resources to help you link your patients immediately for a hassle-free handoff to care. Register for the webinar.

Therapist must be fully licensed

Provider Type: 17

Provider Specialties: 145/Speech-Hearing Therapy Fellow, 170/Physical Therapist, 171/Occupational Therapist, 173/Speech-Hearing Therapist, 174/Occupational Therapy Assistant, 175/Physical Therapy Assistant, 179/Speech-Hearing Therapy Assistant

Effective April 1, 2025, OHCA will no longer accept temporary licenses for therapists and therapy assistants. This was a practice that began during COVID-19 to assist our members and providers during a difficult period. Moving forward, all therapists will need to be fully licensed and verifiable on the applicable licensure board website.

If you have any contract questions, please contact Provider Enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org.

Provider Types/Specialties: 05/050, 05/051, 16/163 17/145, 17/170, 17/171, 17/173, 17/174, 17/175, 17/179, 21/228, 36/361

This session is for providers new to AuthentiCare who will be using the two new OHCA Home Health services — Home Health Aide and Skilled Nursing. It will cover system navigation basics, claim management and dashboards, reporting, mobile application, IVR, and new revenue code functionality.

Providers wishing to register for the Learning Management System, XChange, can use the following link: XChange Registration.

When your completed registration request is approved, you will have access to all materials and upcoming sessions for registration.

Live Training Dates and Times:

• Tuesday, March 11, 2025: 9 a.m.-noon CT
• Tuesday, March 18, 2025: noon-3 p.m. CT
• Wednesday, March 19, 2025: noon-3 p.m. CT
• Wednesday, March 26, 2025: 9 a.m.-noon CT
• Thursday, March 27, 2025: 9 a.m.-noon CT
• Monday, March 31, 2025: noon-3 p.m. CT  

Live training will consist of web portal and mobile application demonstrations, as well as an overview of the system.

After participating in live training, Q&A sessions will answer specific questions that providers have.

Open Q&A Sessions

• Wednesday, April 2, 2025: 1-2 p.m. CT
• Thursday, April 3, 2025: 9-10 a.m. CT
• Tuesday, April 8, 2025: 2-3 p.m. CT

NOTE: All participants need to attend live training to receive credentials. Video recordings will be available after training for a refresher.

Those that do not attend the training will need to participate in the standard scheduled monthly training, which is offered once per month per agency.

If you have any additional questions regarding Electronic Visit Verification (EVV), please send an email to the EVV team at EVV@okhca.org.

PV Types:    01, 08, 31, 52

The year-end C-section rate letters for state fiscal year 2024 are now 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, you can call 800-522-0114. You can also view the SoonerCare C-section rates and reports available on the Cesarean Reports page.

Thank you.

ICF/IID Vocational & Day Services Enhanced Payment - Update

Run Date: 2/24/2025 – 3/07/2025

PV Type: 03/ 31,34

The SFY 2025 third quarter enhanced payment for vocational and day services will be made on

Feb. 26, 2025.

We thank you for your continued service to SoonerCare members.

Nursing Facility Pay for Performance (PFP) Payment Update

Run Date: 2/24/2025 – 3/7/2025

PV Type: 03/30, 35

The SFY 2025 third quarter PFP payment will be made on Feb. 26, 2025.

We thank you for your continued service to SoonerCare members.

Provider Specialties: 180, 188, 196, 330, 543

Effective March 17, 2025, OHCA will require a prior authorization for CPT code 65778 (placement of amniotic membrane on the ocular surface, without sutures). Prior authorization guidelines can be found on the OHCA website. 

Provider Types/Specialties: All

Attention EDI Submitters, Trading Partners, Software Vendors and Providers

OHCA has made an update to the 820 EDI transactions to include the cap rate code. The changes are shown below. Please make any updates to your system as needed. If you have any questions, contact the EDI Help Desk at 800-522-0114, option 2, 2.

Loop 2300B in REF02 will be the new rate code with REF01= ZZ.

ENT*1*2J*34*999887777~
NM1*QE*1*LNAME*FNAME*R***N*000000044~
RMR*AZ*2028SA1**18.67~
REF*ZZ*12345~
DTM*582****RD8*20241201-20241231~

Third-Party Liability Bypass as Primary Payer for School-Based Services Pursuant to an IEP/IFSP

Provider type 12/120 School Corporation

Effective Jan. 1, 2025, following CMS guidance, under section 1903 of the Social Security Act (SSA), the Oklahoma Health Care Authority (OHCA) is advising that Third-Party Liability (TPL) claims regarding Medicaid payment policies will be bypassed for services provided under a Medicaid-eligible students’ Individual Education Program (IEP) or Individualized Family Service Plan (IFSP).

This means that OHCA is permitted to review and pay compliant claims filed by an OHCA contracted qualified school provider as the primary payer for Medicaid compensable services pursuant to and IEP or IFSP.

If you have any questions, please contact Lana Brown at Lana.Brown@okhca.org.

Provider types:  All

Message:  In an effort to assist providers with uploading prior authorization and claim attachments via the OHCA secure provider portal, OHCA has expanded the size limitation of attachments to 30 MB per prior authorization and per claim. Please utilize this option for the most efficient claim and prior authorization review process.

Provider Types: ALL

Effective Jan. 1, 2025, OHCA has made changes to the telehealth Medical Audio-Only list as follows: 

• Removed 99441-99443 as codes ended Dec. 31, 2024. 
• Added coverage for 99212 and 99213 – following CMS to use already established E&M codes and applying appropriate telehealth or audio-only modifiers.
• Removed T1015 – Federally Qualified Health Center (FQHC) services provided by audio-only should be billed fee-for-service (FFS).

See OAC 317:30-3-27 for more information regarding coverage of telehealth services. The updated lists for both medical and behavioral health covered telehealth and audio only services can be found on OHCA’s telehealth page.

Provider Type/Specialty: 08/080

Effective July 1, 2024, OHCA made changes to the Federally Qualified Health Center (FQHC) reimbursement to include CPT 90832 (psychotherapy, 30 minutes with patient and/or family member) as prospective payment system (PPS) instead of fee-for-service (FFS) for FQHCs.

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

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

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

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

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

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

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

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

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

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

A few reminders:

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

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