Global Messages

Provider Types: 53 (Under Supervision)

The following contract expires May 31, 2023:  Behavioral Health Under Supervision. To avoid any delay in reimbursement, OHCA encourages providers to begin the renewal process as soon as possible. Visit the provider training page for a how-to video on renewing your SoonerCare contract. The video is located under the SoonerCare How-To Videos dropdown titled “Renewing your SoonerCare Contract.”

Providers unable to access the OHCA secure provider portal to submit a contract renewal must complete a PIN reset form. The global message dated March 19, 2021, provides instructions on how to complete the PIN reset form.

If you have any questions, please contact provider enrollment at 800-522-0114, option 5, or via email at providerenrollment@okhca.org.

Provider contracts will include language recommending a tobacco-free environment. Implementing a tobacco-free environment is beneficial to employees, patients and visitors as it supports the creation of a safe and healthy workplace, helps protect against second- and third-hand smoke exposure, and encourages people to quit. Generating awareness of this change through signage, decals and other means of communication is highly encouraged. If you need assistance with developing or updating a tobacco-free environment policy or obtaining signage, the SoonerQuit program can assist you with your specific needs. Please email the SoonerQuit team at SoonerQuit@okhca.org for more information.

Provider Types:  01, 08, 31, 52

C-section rate letters for the first six months (July-December) of state fiscal year 2022 are now available through the OHCA provider portal.

If you need help retrieving your letters, please call 800-522-0114.

You may also view the SoonerCare C-section rates and reports on the OHCA C-section page.

Thank you.

Provider Types/Specialties:  010, 014, 325, 326, 331.

Effective July 1, 2023, OHCA is adding PA requirement for CPT 22856 – Insertion of Artificial Spine Disc, Anterior Approach.

Providers: All

Effective April 18, 2023, OHCA has updated coverage for COVID-19 vaccine administration codes as follows:

• Addition of new COVID-19 bivalent vaccination administration codes 0121A, 0141A, 0142A, 0151A, 0171A and 0172A.
• Revision of codes 0124A, 0134A, 0144A, 0154A, 0164A, 0173A and 0174A to include replacing the term “booster” with “additional dose” for bivalent Pfizer and Moderna administration codes.
• Removal of COVID-19 monovalent administration and vaccine codes, 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A 91300, 91301, 91305, 91306, 91307, 91308, 91309, 91311, as they are no longer authorized by the FDA within the United States.

Code Descriptions:
0121A- Pfizer bivalent vaccine, single dose
0141A- Moderna bivalent vaccine, first dose
0142A- Moderna bivalent vaccine, second dose
0151A- Pfizer bivalent vaccine, single dose
0171A- Pfizer bivalent vaccine, first dose
0172A- Pfizer bivalent vaccine, second dose

Additional information can be found on the AMA website. 

Providers: All

Effective May 12, 2023, following the end of the public health emergency (PHE) that was declared in March 2020, OHCA will continue to allow certain services to be provided via telephone or other real-time, interactive, audio-only technology. Providers should adhere either modifier 93 or modifier FQ to show that services are performed using audio-only technology. A list of allowed audio-only service codes can be found on the OHCA Telehealth webpage.

Provider Types/Specialties: 03/030, 031, 034, 035

OHCA has recently made a change for new and renewing nursing facility contracts. Contracts will now require the Survey Document from OSDH (form #2567).  For questions, call Provider Enrollment at 800-522-0114, option 5.  

Provider Types/Specialties: 12/120

SFY 2023 Q3 invoices for the Oklahoma Health Care Authority state share billback has incorrect information in the expenditure field of the invoice, although the billed amount is the correct amount that is owed. If you require a corrected invoice in regards to the expenditure field you can email Tyler Mclemore at Tyler.Mclemore@okhca.org to request.

Provider Types/Specialties: 01/011,012,013,204,205,206; 03/030,031,033-037; 04/040; 05/050,051; 09/093,564; 10/100; 63/630,634.

Effective 5/11/2023: Videoconferencing for MI PASRR Level II will be allowed post-PHE under the following parameters:

1.     Must use the HIPAA compliant version of Zoom provided by the OU College of Nursing (OUCON). The evaluation will be scheduled by the evaluator and the link sent to the referring provider.

2.     If resource or geographic limitations necessitate, videoconferencing may be used when an evaluator is covering a region for another evaluator or completing a two-day emergency assessment.

3.     A face-to-face will be completed if the following limitations are present:

a.     The individual has an intellectual disability that will prevent a thorough comprehensive evaluation due to the individual’s limitations.

b.     The individual is unable to interact via videoconferencing due to medical or behavioral health limitations.

c.      When the individual receiving the PASRR evaluation does not consent to videoconferencing and prefers face-to-face.

d.     An evaluation is started via videoconferencing, and it is deemed by the evaluator that psychosis is present and the member is unable to complete the assessment, even though the member may be medically stable.

4.     Videoconferencing may be used if the nursing facility has an outbreak of any transmittable disease.

5.     Individuals receiving an evaluation must be medically stable and able to communicate with the evaluator (i.e., individuals on a ventilator or unresponsive due to their medical/mental health would not be clinically appropriate to complete the evaluation until medically stable).

6.     For assessments that require two hours of round-trip travel — from evaluation start to completion of evaluator’s final location — videoconferencing may be used.

7.     Telephonic evaluations should be used as a last resort if this is the only means of communication and, if due to a geographic or resource limitation, it would prevent the evaluation from being completed within 7 to 9 business days. The evaluation should only be completed with approval by OHCA and the Oklahoma Department of Mental Health and Substance Abuse Services.

OHCA Psych ID/analyst will request medical records (vitals, height, weight, history and physical, psychiatric records, hospital consults, medications, progress notes, name/contact for individual mental health provider, physician email address, and discharge summary) from the referring provider be sent to the OUCON fax number, 405-271-2626, for the MI PASRR Level II evaluation. This does not take the place of the OUCON face-to-face or videoconferencing evaluation. Medical records must be sent by close of business the day the PASRR Level II evaluation is requested. If medical records are not received by the next business day, the referring provider will need to reorder a Level II PASRR. 

For Resident Reviews: Mental Health Services provided for individual in the past year.

***Please do not send the “Screening for Level II PASRR” to the OUCON fax number. The “Screening for Level II PASRR” must be filled out by the referring provider including the member’s RID number (SoonerCare number if applicable) and faxed to OHCA at 405-530-7260. Any delays in completing this form completely could result in a delay with the evaluation.

Providers: All

Effective 5/12/23, OHCA will end the expanded use of telehealth as allowed during the public health emergency (PHE) that was declared in March 2020. OHCA will continue to allow services provided via telehealth for select medical and behavioral health services. A list of allowed telehealth services can be found at the following link: Telehealth (oklahoma.gov).  

Provider Types/Specialties: 05/050, 051; 06/060; 08/087, 193; 11/110, 111, 118; 17/170; 25/250; 26/260, 261; 28/280; 29/290, 291; 53

Dear Providers,

Due to the public health emergency (PHE) that stemmed from COVID-19, OHCA suspended our normal site visit procedure. As the PHE ends, we are required to resume our normal practice of conducting a site visit before a contract is approved.

Effective immediately, all contract types that require a site visit will be pended until the site visit has been completed and approved. Per federal requirement 42CFR §455.432, pre-enrollment site visits of providers who are designated as “moderate" or "high" categorical risks are required. The purpose is to verify that the information submitted to the Oklahoma Health Care Authority (OHCA) by a provider is accurate and to determine compliance with federal and state enrollment requirements. The site visit may be unannounced.

Upon arrival at the location, we will verify the physical address. If the location is closed, we will determine if the business appears to be operational. If so, we will make plans for another site visit and allow only one other opportunity for a successful site visit. If after two attempts at a site visit the OHCA representative is unable to make contact and tour the facility, a recommendation will be made to deny enrollment.

Provider Types/Specialties: 17/ 176-178

During this webinar from 10-11:30 a.m., Tuesday, April 18, providers will learn about ABA medical necessity criteria and prior authorization.

Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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.

All SoonerCare Providers

Due to COVID-19, Medicaid renewals were paused. However, Oklahoma will soon be required to restart eligibility reviews for all SoonerCare members, ineligible members will be disenrolled from SoonerCare over a period of 9 months, with some members losing eligibility effective 4-30-2023. 

For more information visit the Provider page https://oklahoma.gov/ohca/providers.html under resources you may view the document and video “Determining Member Eligibility”.

There will be a special enrollment period on the Affordable Care Act Marketplace for those who lose their Medicaid coverage due to the return of eligibility renewals. The special enrollment period will stretch from March 31, 2023, to July 31, 2024.

If you have a member who has questions about this process, please refer them to MySoonerCare.org where they can update their information and find an FAQ about this process. If they still have questions, they can also call the SoonerCare helpline at 800-987-7767. 

Because members will lose coverage in phases, it is important providers verify eligibility on the date of EVERY service and not use a date span.

Provider Types/Specialties: 01, 08, 09, 10, 31, 52

Effective April 1, 2023, OHCA will increase the limits for Osteopathic Manipulation Therapy codes 98925-98929 for adults from two (2) treatments per month to four (4) treatments per month. If more than four treatments per month are deemed necessary, a prior authorization override is allowed. There is no limit for medically necessary OMT therapy for children ages 0-20. 

Provider Types/Specialties: 08/208, 56/567

Effective March 2023, contracts with OHCA for Diabetic Educators will have a name change to Diabetes Educators. For questions or concerns regarding this change, contact OHCA Provider Enrollment at 800-522-0114 option 5. 

Provider Types/Specialties: 27/270-279, 08/080-081 & 086

The D7473 has been updated in our systems to reflect the correct quadrants per the ADA standards of quadrant listings of 30 and 40. If you have submitted a prior authorization using R, L or 02 that has been approved but the claim is not paying due to the quadrants listed, please contact the dental authorization unit at 405-522-7401. If you have an authorization recently submitted and approved using R, L or 02, please select to amend the lines of the prior authorization approval and request the correct quadrants according to the ADA.

Provider types: 08, 09, 10,13, 16, 31, 52

The Focus Forward Oklahoma Program is working to address issues related to access and utilization of long-acting reversible contraceptives (LARC).

Focus Forward Oklahoma offers no-cost LARC training to Oklahoma providers, clinical support staff and administrative staff. For more information about Focus Forward and available training visit http://focusforwardok.org/.

Provider Types/Specialties: 09, 10, 14, 15, 17, 18, 20, 23, 31, 52, 53, 57

OHCA is asking rendering providers to complete a survey about their experience with SoonerCare. The postcard with a link to the survey is in the mail. Surveys are due by April 28.

Your feedback is invaluable, and we are committed to using it to improve your experience and help you serve SoonerCare members.

Provider Types: 08, 09, 10, 31, 52

Effective immediately, professional claims with place of service 22 (outpatient) will no longer require referrals from the primary care physician. 

Provider Types/Specialties: 17/ 176-178

During this webinar from 2-3:30 p.m., Thursday, March 30, providers will familiarize themselves with an overview of ABA medical necessity criteria and prior authorization.

Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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.

Provider Types: 08, 09, 10, 31, 52

Effective for dates of service beginning March 1, 2023, OHCA will begin reimbursing for an evaluation and management service in addition to an Early Periodic Screening, Diagnosis and Treatment (EPSDT) screening for children ages 0-20 when appropriate. The EPSDT screening is still considered a comprehensive examination. However, if a member is receiving an EPSDT screening and an additional focused complaint arises that requires additional evaluation and management to address the complaint, the provider may deliver all medically necessary care and submit a claim for both the EPSDT screening and the appropriate level of focused service if the following requirements are met:

• The medical issue is significant enough to require additional work to address the issue.
• The visit is documented on a separate note.
• There is appropriate documentation that clearly lists the condition being managed at the time of the encounter and supports the billing of both services.
• Modifier 25 is added to the appropriate code that indicates that a separate evaluation and management service was provided by the same physician on the same day as the EPSDT screening. All claims submitted with Modifier 25 will be reviewed prior to payment.
• The following items will be reviewed prior to any payment:
  • Medical necessity.
  • Appropriate utilization of Modifier 25.
  • Appropriate level of service billed.
  • All documentation to support both the EPSDT screening and the additional evaluation and management for a focused complaint must be submitted for review.

When providing evaluation and management of a focused complaint during an EPSDT screening, the provider may claim only the additional time that is required above and beyond the completion of the comprehensive EPSDT screening.

An insignificant or trivial problem that is encountered in the process of performing the preventive evaluation and management service and does not require additional work is included in the EPSDT visit and should not be billed/reported.

Additional information regarding EPSDT visits can be found in OHCA Policy PART 4. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program/Child Health Services (oklahoma.gov).

PV Type:  03/30, 35

SFY 2023 Third Quarter PFP payment will be made on Feb. 22, 2023.

We thank you for your continued service to SoonerCare members.

PV Types:    01, 08, 31, 52

The year-end C-section rate letters for state fiscal year 2022 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.

Provider Types/Specialties: All

During this webinar from 2-3:30 p.m., Thursday, Feb. 16, providers will familiarize themselves with an overview of OHCA’s Third Party Liability and HMS process.

Visit the OHCA Provider Training page to register. You will receive a confirmation email with 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.

Target Audience: Eye Care Providers

Each year, Oklahoma Health Care Authority performs a random sample audit of SoonerCare claims. This year’s review showed a higher-than-normal error based on the eye care provider maintaining records that document the SoonerCare member having received, picked up, being fitted, or being delivered frames, lenses, etc. 

As a reminder, please have the member or representative sign for the eyewear and maintain medical records for a minimum of six years per OAC 317:30-3-15. Record retention.

Providers: 27/270-279, 08/080-081 & 086

The Oklahoma Healthcare Authority has recently undergone a fee adjustment that was set with the effective date of Oct. 1, 2022. Claims filed from that date forward undergo claims recycle that is in progress. Per policy, providers are required to indicate their usual and customary charge when submitting claims. Providers who bill the SoonerCare allowable fee are advised to void and refile their claims from date of service Oct. 1, 2022 forward with their fees per policy. Please see Usual and Customary fee policy found at 317:30-3-5.1. Usual and Customary fees (oklahoma.gov)

Providers: Hospital (01), Clinic (08), Advance Practice Nurse (09), Mid-Level Practitioner (10), Laboratory (28), Physician (31), State Employed Physicians (52)

In May 2022, OHCA made updates in the MMIS claim system to change modifier 90 (reference [outside] laboratory) from an informational modifier to a denial modifier. OHCA has now set modifier 90 back to be an informational-only modifier, effective May 12, 2022.  Providers who received denials for claims lines where modifier 90 was applied may now refile those claims, if appropriate. Timely filing rules will apply. 

Providers: All

OHCA has updated coverage for laboratory testing of infectious diseases using molecular testing (CPT 87471-87801) effective Jan. 1, 2023. Providers will find the updated coverage guidelines on the Medical Authorization Unit’s webpage.

Changes include reopening coverage for CPT code 87634 (RSV) and 87637 (COVID-19, Flu A&B, and RSV) when performed by hospital labs, independent labs or clinic labs for symptomatic individuals who are immunocompromised, have chronic respiratory illness or influenza complicated by pneumonia, or who are pregnant.  

Target Audience: Licensed Oklahoma Providers and Organizations

OHCA will present a webinar titled Improving Care Coordination, Delivery, and Quality Utilizing Oklahoma’s Health Information Exchange at 12 p.m., Thursday, January 26. This webinar will provide the details of recent legislation regarding participation in Oklahoma’s state-designated Health Information Exchange (HIE), review the capabilities and benefits of utilizing the HIE to provide care and services, and discuss the process for joining and getting connected to the HIE.

Presenters:
Stephen W. Miller, CHCIO (State Coordinator for Health Information Exchange)
David C. Kendrick, MD, MPH (CEO, MyHealth Access Network)

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.