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Provider Update: August 16, 2018

To: All ADvantage Providers

Subject: Billing Process for ADvantage Services Impacted by Rate Increases

The Oklahoma Health Care Authority (OHCA) has advised that, due to rate increases being legislatively mandated, certain Provider types will not have to void claims for dates of service beginning July 1, 2018, and refile under the new rate.  OHCA will be recycling certain claims that have already been processed and paid.  This means that:

  • Any billing previously submitted for dates of service beginning July 1, 2018 or later, for the claim types noted below, will automatically be "recycled" to the higher rate.
  • This change will be implemented by OHCA after the Harmony go-live date – additional information will be forthcoming as dates are finalized.

Provider types whose billing will be recycled, and who will not have to void and rebill, include:

  • Personal care services – T1019, T1019-TF
  • Respite – T1005, S9125
  • All case management services – T1016, T1016-U3, T1016-TN, T1016-TNU3
  • All nursing services – G0299, G0299-TF, G0300, G0300-TF, T1002
  • All assisted living tiers – T2031, T2031-TF, T2031-TG

Consumer directed services will also recycle, however as PSA/APSA pay rates are set by the individual Member, there will be limited visible changes to these services.

Provider types whose billing WILL NOT be recycled include:

  • Adult day health – S5100-U1, S5105-TG, S5105
  • Hospice – S9126
  • Home delivered meals – S5170

Due to the way these rates are set in the OHCA claims system, all claims for these service

types that have been billed from 7/1/2018 to the date when authorizations are updated in Harmony will have to be voided and rebilled at the higher rate.  Additional information will be forthcoming as dates are finalized.

If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at:

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