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Provider Update: December 11, 2015

New Nursing Codes Rates and Priority Request Clarification and fax reminder

Reminder;

Effective December 31, 2015 the code currently used for skilled Nursing Home Health Setting G0154 and the code used for Extended State Plan Skilled Nursing G0154-TF will be retired.

G0299Registered Nurse-Skilled Nursing-Home Health Setting

G0299-TF      Registered Nurse Extended State Plan Skilled Nursing

G0300            Licensed Practical Nurse/Licensed Vocational Nurse- Home Health Setting

G0300-TF      Licensed Practical Nurse/Licensed Vocational Nurse - Extended State Plan                             
Skilled Nursing

Nursing Code Rates

Service Code Unit Measure Rate Terminated Code
G0299 Registered Nurse-Skilled Nursing-Home Health Setting 15 minutes $13.50 G0154
G0299-TF Registered Nurse Extended State Plan Skilled Nursing 15 minutes $13.50 G0154 TF
G0300 Licensed Practical Nurse/Licensed Vocational Nurse- Home Health Setting 15 minutes $13.50 G0154
G0300-TF Licensed Practical Nurse/Licensed Vocational Nurse - Extended State Plan                              Skilled Nursing 15 minutes $13.50 G0154 TF

Information regarding the Provider Audits:

This change will not impact provider audits for fiscal year (FY) 2016. Any changes to provider audits for future years will be communicated via the Quality Assurance/Improvement department at that time.

All Providers shall adhere to the following legal source documents, which do not contradict but support and further define each other, the Federal Medicaid Statutes and Regulations, the OHCA Medicaid Contract, Oklahoma Administrative Code, State statutes and rules governing practice of provider's service profession, Conditions of Provider Participation in the ADvantage Program, ADvantage Program Service Standards, the ADvantage Program Member Assurances and any additional federal, state, or local regulations that may apply.

PRIORITY REQUESTS REQUIREMENTS:

Timely processing of Service Plan requests is our number one priority. In an effort to improve our ability to sort and process service plan documentation we are requesting your immediate cooperation with the following submission procedures.

Priority requests are services that need to be authorized immediately to protect a member's health and welfare.

Only PRIORITY Service Plan Authorization correspondence should be faxed to (405) 230-8019. Please ask all of your Case Managers to immediately cease sending anything but priority documentation via fax.

A priority request should include the cover sheet with the priority status clearly identified and justification for the request. Requests with cover sheets that do not indicate the priority status or justification will not be routed for immediate review.

DUPLICATE SUBMISSIONS:

Unless directed to do so by MSU Provider Question or another MSU source, please DO NOT resend a request either by mail, fax or hand delivery. Time spent researching whether or not documents have already been processed is time not spent reviewing original service plan requests.

If you have any questions or concerns regarding the information provided above, please feel free to contact us via Smarter Mail at:  aauproviderquestion@aau.okdhs.org 

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