Provider Update: December 26, 2019

To:State Plan Personal Care (SPPC) Home Care Providers

Subject:SPPC Authorization Changes

Historically, SPPC authorizations have transmitted from the DHS IMS system to the Oklahoma Health Care Authority (OHCA) where the lines are then split into 12 monthly authorizations. Every year the authorizations have ended 12/31 of the current year and new authorizations were created for 1/1 of the new year.

A change in processing of SPPC Authorizations is being made to better streamline the authorization process and mirror the ADvantage authorization process. Below are some of the key facets of the change:

• Effective 12/30/2019 Harmony will send SPPC authorizations to OHCA in the nightly PA file that is currently used to transmit ADvantage authorizations. 
   
• SPPC authorization numbers will begin with the prefix '26.' The ADvantage prefix is '25.'
  
  
• On 12/30/2019, all 1/1 and forward authorizations that have been on hold in Harmony will be released following the new process and sent in the PA file to OHCA that night.

• On 12/31/2019, all 1/1 and forward authorizations should be showing in the AuthentiCare system.

• All authorizations created on 12/31/2019 and forward will no longer split at the end of the calendar year.  They will be sent to both OHCA and AuthentiCare for the full authorization time period, consistent with service plan year dates.

• T1001 will continue to transmit from Harmony directly to AuthentiCare. T1001 is not a prior authorized service but rather a placeholder in AuthentiCare to create the record and allow for billing.
  
   

*Please send any questions regarding the above information using a PQ ticket in Harmony.