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Global Messages

2022 Global Messages

Date Posted Title Message
1/20/22 SoonerCare Provider Contracts Webinar

Provider Types/Specialties: All

OHCA will present a webinar titled SoonerCare Provider Contracts on Tuesday, Feb. 22, 2022, at 2 p.m.

This webinar is a comprehensive overview of OHCA’s SoonerCare provider enrollment process with information on new contracts and contract renewals, and helpful tips for efficiency and accuracy.

Target Audience:  all Oklahoma Medicaid providers and staff.

Visit the OHCA Provider Training page to register.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

1/19/22 Eligibility in regard to Prior Authorizations

Provider Types/Specialties:  08/081, 082, 086; 27/270-279

This message serves as a reminder that providers are responsible for checking member eligibility. Prior authorization end dates are generally set at six months from date of authorization. If a member should lose eligibility before that date, and a claim is made for a service after loss of eligibility, the claim will not pay. Please be diligent in checking eligibility before providing services.

1/19/22

COVID-19 Treatments

Providers: All

OHCA covers the following COVID-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA:

  • 91300 - Pfizer BioNTech COVID-19 vaccine
    • 0001A - Pfizer BioNTech COVID-19 vaccine administration, first dose
    • 0002A - Pfizer BioNTech COVID-19 vaccine administration, second dose
    • 0003A - Pfizer BioNTech COVID-19 vaccine administration, third dose
    • 0004A - Pfizer BioNTech COVID-19 vaccine administration, booster dose
       
  • 91301 - Moderna COVID-19 vaccine
    • 0011A - Moderna COVID-19 vaccine administration, first dose
    • 0012A - Moderna COVID-19 vaccine administration, second dose
    • 0013A - Moderna COVID-19 vaccine administration, third dose
       
  • 91303 - Johnson & Johnson/Janssen COVID-19 vaccine
    • 0031A - Johnson & Johnson/Janssen COVID-19 vaccine administration, first dose
    • 0034A - Johnson & Johnson/Janssen COVID-19 vaccine administration, booster dose

  • 91306 - Moderna COVID-19 vaccine low dose
    • 0064A - Moderna COVID-19 vaccine (low dose) administration, booster dose

  • 91307 - Pfizer BioNTech COVID-19 pediatric vaccine
    • 0071A - Pfizer BioNTech COVID-19 pediatric vaccine administration, first dose
    • 0072A - Pfizer BioNTech COVID-19 pediatric vaccine administration, second dose

  • M0201 - COVID-19 vaccine home administration


OHCA covers the following COVID-19 monoclonal antibodies and administration when used in accordance with the emergency use authorization (EUA) 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.

  • Q0243 – Injection, casirivimab and imdevimab, 2400 mg (Regeneron), first dose

  • Q0244 – Injection, casirivimab and imdevimab, 1200 mg (Regeneron), first dose
    • M0243 – Intravenous infusion or subcutaneous injection, casirivimab and imdevimab 2400 mg or 1200 mg, infusion or injection, and post administration monitoring (Regeneron), first dose
       
  • Q0240 – Injection, casirivimab and imdevimab, 600 mg (Regeneron), subsequent or repeat doses
    • M0240 – Intravenous infusion or subcutaneous injection, casirivimab and imdevimab 600 mg, includes infusion or injection and post administration monitoring (Regeneron), subsequent or repeat doses
       
  • Q0245 – Injection, bamlanivimab and etesevimab, 2100 mg
    • M0245 – Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
       
  • Q0247 – Injection, sotrovimab, 500 mg
    • M0247 – Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
       
  • Q0249 – Injection, tocilizumab, 1 mg
    • M0249 – Intravenous infusion, tocilizumab, includes infusion and post administration monitoring, first dose
    • M0250 - Intravenous infusion, tocilizumab, includes infusion and post administration monitoring, second dose

OHCA also covers Evusheld (tixagevimab co-packaged with cilgavimab) for the pre-exposure prophylaxis of COVID-19 for adults and pediatric members 12 years of age and older (weighing at least 40kg) with no known COVID-19 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).    

  • Q0220 – Injection, tixagevimab 150 mg and cilgavimab 150 mg
    • M0220 - Injection, tixagevimab and cilgavimab, includes injection and post administration monitoring.
1/19/22 Acute Hospital Care at Home

Provider Types: 01

As a reminder, inpatient facilities can apply through CMS for the ability to provide some inpatient services to patients in their home. Each facility must apply individually. Additional information can be found at https://qualitynet.cms.gov/acute-hospital-care-at-home.

1/14/22 Long-Acting Reversible Contraceptives in an FQHC

Provider Types/Specialties:  08/080

Effective Dec. 30, 2021, OHCA will allow reimbursement for long-acting reversible contraceptives (LARC) in addition to the FQHC encounter rate. 

The compensation for the LARC will be at the current fee-for-service rate.

Please view Provider Reimbursement Notice 2022-01 for more information.

1/11/22 Modifier 25 and 59 Medical Review Bypass Code Lists

OHCA has provided a list of procedure codes that do not require documentation review when billed with modifier 59 to indicate a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day.

Likewise, OHCA has also provided a list of E/M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes to indicate a significant separately identifiable service was performed on the same day.   

Both these lists and other information regarding NCCI edits can be found on the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html.

1/10/22 C-Section Rate Letters

Provider Types: 1, 8, 31, 52

The year-end C-section rate letters for state fiscal year 2021 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.

1/7/22 Member Demographic Change Process

Provider Types/Specialties:  All

Beginning February 1, 2022, OHCA will no longer accept Member ID Correction forms. Providers should contact the SoonerCare Helpline at 800-987-7767 to report any member demographic changes. Agency Partners should contact the number above and then select option 4 and enter their PIN to access the Agency Partner Helpline. 

1/7/22 PT/OT/ST Developmental Testing

Provider Specialties: 087, 170, 171, 173, 182

Effective Feb. 1, 2022, OHCA will no longer separately reimburse for developmental testing performed by physical therapists, occupational therapists or speech therapists utilizing CPT codes 96112 and 96113.

Codes used to bill therapy evaluation services already include reimbursement for any testing that may be required to develop a therapy treatment plan.  

CPT 96112 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour  

CPT 96113 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes   

1/7/22 Soon-to-be-Sooners Limited Dental Benefits

Provider Types/Specialties:  08/081, 086; 27/271, 272, 274, 275

Effective Jan. 1, 2022, Soon-to-be-Sooner members (STBS/STBS-M) are eligible for limited dental benefits, which are necessary for the health and well-being of the unborn child during pregnancy and birth. Providers will be compensated for providing the following dental codes when medically necessary.

  • D1110 Prophylaxis
  • D1206 Fluoride varnish
  • D4346 Scaling in presence of inflammation
  • D4342 Scaling and root planing 1-3 teeth/quadrant
  • D4341 Scaling and root planing 4 or more teeth/quadrant
  • D7140 Extraction erupted tooth
  • D7210 Extraction erupted tooth
  • D0120 Periodic oral evaluation
  • D0140 Limited oral evaluation
  • D0150 Comprehensive oral evaluation
  • D0220 Intraoral – periapical first radiographic image
  • D0230 Intraoral – periapical each additional radiographic images
  • D0272 Bitewing – two radiographic images
  • D0274 Bitewing – four radiographic images
1/3/2022 SoonerCare Choice Referrals Webinar

Provider Types/Specialties: All

OHCA will present a webinar titled SoonerCare Choice Referrals on Thursday, Feb. 10, 2022, at 2 p.m. and Thursday, Feb. 24, 2022, at 2: p.m.

This class will discuss the SoonerCare Choice referral guidelines for members enrolled with a patient-centered medical home provider and provide instructions on administrative referral requirements.

Note: Referrals submitted through the OHCA secure provider portal by I/T/U providers to specialists will not be covered.

Target Audience: SoonerCare Choice primary care providers and medical homes who issue referrals and specialists who receive referrals.

Visit the OHCA Provider Training page to register.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

 

Last Modified on Jan 20, 2022