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Global Messages

2021 Global Messages

Date Posted Title Message
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.
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.

https://okhca.zoom.us/webinar/register/WN_CmwkufzmQIGvA7gGBOQiiQ

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.

https://okhca.zoom.us/webinar/register/WN_rMuCD70GSBCsgDUiY3Muxg

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.: https://okhca.zoom.us/webinar/register/WN_1B8L-CkyTlqwlBZvxF6V2A

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 Mar 03, 2021