Global Messages
2025 Global Messages
| DATE POSTED | TITLE | MESSAGE |
|---|---|---|
| 4/15/25 | SoonerCare General Provider Agreement | Provider Types: All The Oklahoma Health Care Authority (OHCA) has updated the SoonerCare General Provider Agreement to include a new provision related to the offshoring of services and data. We encourage all providers to review the updated agreement to ensure continued compliance. If you have questions, contact OHCA Provider Enrollment at ProviderEnrollment@okhca.org or 800-522-0114, option 5. |
| 4/15/25 | Rescheduled Network Maintenance – Thursday, April 24 at 9 p.m. | Provider Types: All Please be advised that network maintenance has been rescheduled to 9 p.m., Thursday, April 24. You may experience service disruption for up to one hour. During this timeframe, all production sites, including public sites, will be down for at least 10 minutes. This includes Provider Portal, Agency View, Business Objects, COLD, CTX, EPE Workflow, Extranet, iCE, Initiate, Letter Generator, MedAI, PA, PI, Project Workbook and SOA. |
| 4/14/25 | Network Maintenance – April 17 at 9 p.m. | Provider Types: All Please be advised that network maintenance will take place at 9 p.m., Thursday, April 17, and you may experience service disruption for up to one hour. During this timeframe, all production sites, including public sites, will be down for at least 10 minutes. This includes Provider Portal, Agency View, Business Objects, COLD, CTX, EPE Workflow, Extranet, iCE, Initiate, Letter Generator, MedAI, PA, PI, Project Workbook and SOA. |
| 4/10/25 | Differentiation for D1354 | Provider Types: 27/270-279, 08/080 & 086 Provider letter 2025-11 SoonerSelect dental clarification for utilization of D1208 (topical application of fluoride excluding varnish), D1354 (application of carries arresting medicament per tooth), D1355 (caries preventive medicament for application per tooth), and D2991 (application of hydroxyapatite regeneration medicament per tooth) is now available on the provider letters page of the OHCA website. The letter informs providers of how to appropriately utilize D1354 for the use of silver diamine fluoride (SDF). |
| 4/2/25 | Incentive Payment | Provider Type/Specialty 11/110 Thank you for your patience as we work through the provider incentive payment program. The 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 billing provider cannot be:
The supplemental payment will be for SoonerSelect paid claims with dates of services from April through December 2024. You will only receive payment from one contracted entity, but all qualifying SoonerSelect paid claims will be enhanced in this and future payments.
View the payment schedule on the OHCA’s SHOPP Forms and Reports page. You can also view additional information on the provider incentive directed payment program. |
| 3/31/25 | Paraprofessional Renewals 2025 |
Provider Type: 11/123 The renewal period for paraprofessional providers is approaching, with the renewal option expected to open in the portal on or around April 17, 2025. OHCA is currently reviewing paraprofessional enrollments to ensure certifications are active and cover the full enrollment period. Renewals with certification gaps will not be processed unless updated certificates are submitted covering those gaps. To help ensure timely processing, providers should review and update any expired or missing certifications in their individual provider file before the renewal period begins. Please reach out to Provider Enrollment at 800-522-0114, option 5, or ProviderEnrollment@okhca.org if you have any questions. |
| 3/21/25 | Liberty Dental Plan Request to Change Service Provision | Provider Types: 27/270-279, 08/080 & 086 Provider Letter 2025-10 SoonerSelect Dental Changes to Claims Processing for Therapeutic Pulpotomies, Gross Pulpal Debridement and Endodontic Therapy for Liberty is now available on the provider letters page of the OHCA website. The letter informs providers that Liberty Dental Plan will implement changes related to claims processing for therapeutic pulpotomies, gross pulpal debridement and endodontic therapy for dates of services on or after April 1, 2025. |
| 3/17/25 | 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 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. |
| 3/12/25 | Provider Request for New or Expanded SoonerCare Coverage Consideration | 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. |
| 3/6/25 | SBIRT Incentive Program Webinar | 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. |
| 3/6/25 |
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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. |
| 3/5/25 | AuthentiCare Home Health 2.0 Training Registration | 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:
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
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. |
| 3/3/25 | C-Section Rate Letters | 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. |
| 2/24/25 | Long-Term Care Enhanced Payment Update | 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. |
| 2/24/25 | Long-Term Care PFP Payment Update | 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. |
| 2/14/25 | PA for 65778-Ocular Amniotic Membrane Placement | 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. |
| 2/12/25 | 820 Cap Rate Code Changes | 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~ |
| 2/12/25 | 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. |
| 2/6/25 | Expanded size limitation for attachments | 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. |
| 1/30/25 | Audio Only Code Update (CORRECTED) | Provider Types: ALL Effective Jan. 1, 2025, OHCA has made changes to the telehealth Medical Audio-Only list as follows:
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. |
| 1/29/25 | FQHC Reimbursement Change for 90832 | 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. |
| 1/16/25 | Action forms for panel increases (SC-13) are being discontinued immediately | 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. |
| 1/2/25 | Second round of Provider Incentive Program Payments | 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:
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 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. |
Archived
Global Messages
2024 Global Messages
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2019 Global Messages
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2015 Global Messages
2014 Global Messages
2013 Global Messages
2012 Global Messages
2011 Global Messages
2010 Global Messages
2009 Global Messages
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2007 Global Messages
2006 Global Messages
