Library: Policy

317:35-17-12. Certification for ADvantage program services

Revised 9-14-18

(a) Application date. When the applicant is determined eligible for ADvantage, his/her certification is effective the date that medical and financial eligibility was determined. When eligibility or ineligibility for ADvantage program services is established, the worker updates the authorization and the computer-generated notice is mailed to the member and ADvantage Administration (AA). • 1

(b) Financial certification period. The financial certification period is twelve (12) months.

(c) Medical Certification period. The medical certification period is twelve (12) months. Redetermination of medical eligibility by an Oklahoma Department of Human Services (DHS) nurse is:

(1) completed annually in coordination with the annual reauthorization of the member's patient-centered service plan.

(2) completed when documentation is received that supports a reasonable expectation the member may not continue to meet medical eligibility criteria.

INSTRUCTIONS TO STAFF 317:35-17-12

Issued 1-15-19

1.The Oklahoma Health Care Authority no longer issues or prints copies of medical identification (ID) cards.Providers verify a member's eligibility by accessing the Eligibility Verification System, also known as the "Provider Network," at www.okhca.org  through the Provider Portal.When members need a physical card community resources purposes:

(1) Online Enrollment members may log on to their Online Member Account and print the card; and

(2) Non-Online Enrollment members may contact the local Oklahoma Department of Human Services (DHS) county office to obtain a printed version of the card.DHS staff enters the member's information into the Eligibility tab on the Medicaid Management Information System (MMIS) Extranetand clicks on the link "Display Member ID Card" to print a copy of the front and back of the medical ID card.