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Global Messages

2022 Global Messages

Date Posted Title Message
6/30/22 Hospice Services for Expansion Adults in Long Term Care Facilities

Effective Oct. 1, 2022, Expansion Adults residing in long-term care (LTC) facilities, including nursing facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), may receive hospice services.

NF and ICF/IID room and board per diem rates are reimbursed to the in-home hospice provider at a rate equal to 95% of the facility’s per diem rate. Hospice providers are responsible for passing the room and board payment through to the NF or ICF/IID.

If Medicare is the primary payer of hospice benefits, OHCA will only reimburse the hospice provider for coinsurance and deductible amounts and will continue to pay the room and board to the nursing facility.

For additional information, please contact the LTC Financial Management Unit at 405-522-7306.

6/22/22 Patient-Centered Medical Home (PCMH) Redesign Obesity Performance Measure and New Provider Scorecards

Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 

OHCA will present a webinar titled Patient-Centered Medical Home (PCMH) Redesign Obesity Performance Measure and New Provider Scorecards on Thursday, July 21 at 2 p.m.

This webinar will provide an overview of the SoonerCare Choice Obesity Performance Measure and Provider Scorecards. Attendees will learn about the requirements of the Obesity performance measure, new provider scorecards, and an upcoming opportunity to participate in voluntary mock audits. 

Target Audience: Current and prospective patient-centered medical home providers and staff. 

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org

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.

6/13/22 Physical Therapy and Occupational Therapy Use of SC Modifier Clarification

Provider Types/Specialties: 08/087, 17/170-171, 174-175

The use of the SC modifier is appropriate when submitting a physical therapy or occupational therapy prior authorization request for initial post-operative surgeries and acute injuries.

Please note the current therapy modifiers are still required – GP for physical therapy and GO for occupational therapy.

The Oklahoma Health Care Authority defines post-operative surgeries and acute injuries as follows

  • Post-Operative Surgeries – No greater than three months from the date of the initial surgical procedure.
  • Acute injuries – No greater than two weeks from the initial injury date.

Inappropriate use of the SC modifier will result in a cancellation of the prior authorization request. All cancelled prior authorization requests must be resubmitted as a new request.

Please remember OHCA does not allow submission of retro requests for therapy.

6/10/22 Qualifying Clinical Trials

Provider Types/Specialties: All

Effective immediately, when requesting a prior authorization (PA) for a surrounding service associated with a qualifying clinical trial, please add a Q1 modifier to the service code. The Q1 modifier clarifies that the service code being requested is a “routine clinical service provided in an approved clinical research study.”

6/10/22 Chiropractor Resources

Provider Types/Specialties: 08/187, 15/150

In an effort to reduce the number of opioid prescriptions for back pain, OHCA implemented alternative treatments for pain management effective Jan. 1, 2022, consisting of coverage for chiropractic care for adults ages 21 years and older.

A Guide for SoonerCare Chiropractors has been published to the provider training page to help chiropractors become familiar with coverage, contracting requirements, verifying SoonerCare member eligibility and prior authorization for services. Additionally, a chiropractors and SoonerCare webinar recording is available to view with the respective Q&A document on the provider training page under the Previous Webinars section of the page.

For any questions, please call the OHCA provider helpline at 800-522-0114 or email SoonerCareEducation@okhca.org.

5/31/22 RE: PCMH Mock Audits for Compliance Reviews

Provider Types/Specialties: 08/082, 088; 09/093; 10/100; 31/316, 318, 322, 344, 345, 568

The Quality Assurance (QA) department at the Oklahoma Health Care Authority will be conducting mock audits for medical record compliance review as a part of ongoing efforts to innovate the SoonerCare Choice Patient-Centered Medical Home (PCMH) program.

You can register online for the mock audits starting Aug. 1, 2022, through Nov. 10, 2022. Participation is voluntary.

Please reference Provider Letter 2022-06 for more information about signing up for the mock audits.

5/26/22 

Long Term Care PFP Payment Update

Provider Types/Specialties: 03/030, 035

SFY2022 4th Quarter PFP payments will be made on May 25, 2022.

We thank you for your continued service to SoonerCare members.

5/19/22 Dental Prior Authorization and Amendments Webinar

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

OHCA will present a webinar titled “Dental Prior Authorization and Amendments” on Tuesday, June 7 at 2 p.m.

This webinar will provide a current look at covered dental services requiring a prior authorization, the documents required for each submission and how to submit a prior authorization and amendment on the SoonerCare provider portal.

Target Audience: dentists, orthodontists and administrative staff.

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.

NOTE: To streamline the amendment process, the Dental Authorization Unit is implementing a change in the orthodontic banding and prior authorization amendment requests.

Effective immediately, providers can submit their amendment requests, including orthodontic bandings, through the secure provider portal. This will be the only acceptable way to submit such request starting June 10, 2022.

5/18/22 Electroencephalogram (EEG) in Inpatient Facility

Provider Types/Specialties: 010, 014, 326 and 523

Providers are reminded there is no prior authorization required for physician interpretation and report services for long term EEG monitoring when performed while a member is inpatient.

Affected codes are: 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725 and 95726.

5/17/22 LTC Cost Report & QOC Submission Training Webinar

Provider Types/Specialties:  Extended Care Facility (03)/(030) Nursing Facility, (031) ICF/IID > 6 beds, (034) ICF/IID < 6 beds & (035) Skilled Nursing Facility

OHCA will present a webinar titled "LTC Cost Report & QOC Submission Training” on Thursday, June 9 at 10 a.m. This webinar will provide detailed instructions on how to submit both the Quality of Care Monthly Report, and the Annual LTC Cost Report.

Target Audience: All Medicaid Long-Term Care Facilities

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.

5/16/22 Laboratory Billing Reminders

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

Per OHCA policy, laboratory services must be billed by the laboratory that performs the testing. It is not appropriate for a provider to bill for lab testing they refer to another laboratory to perform. See OAC 317:30-5-20 Laboratory Services for more information.

Modifier 91 is only to be used to report a subsequent medically necessary laboratory test on the same day of the same previous laboratory test.  More information on the appropriate use of Modifier 91 can be found at the following link.

5/11/22 Contracts Expiring June 30, 2022

Provider Types: 24, 25

The following contracts expire June 30, 2022: Pharmacy, DME and medical supplies.

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”.

Additionally, 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 e-mail 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. In addition, 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.

5/2/22 C-Section Rate Letters

Provider Types: 01, 08, 31, 52

C-section rate letters for the first half 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 available at www.okhca.org/c-section.

Thank you.

4/27/22 High Risk OB Prior Authorization Changes

Provider Types/Specialties: 31, 52/328, 335, 568

To streamline the high-risk OB PA process and to cut down on the need for an amendment to change units from one code to another, procedure group codes have been created.

Effective immediately, you can submit your PA request using the appropriate group code listed below (modifiers not required) and you will continue to file your claims using the appropriate CPT code and modifiers.

  • Single Fetus – allowed billing modifiers TC and 26
    • Request MA001 (76815 + 76816 + 76817) may request up to 3 units
    • Request MA002 (59025 + 76818 + 76819) may request up to 5 units
  • Twins – allowed billing modifiers 59, TC and 26
    • Request MA003 (76815 + 76816 + 76817) may request up to 6 units
    • Request MA004 (59025 + 76818 + 76819) may request up to 10 units
  • Triplets – allowed billing modifiers 59, 76, TC and 26
    • Request MA005 (76815 + 76816 + 76817) may request up to 9 units
    • Request MA006 (59025 + 76818 + 76819) may request up to 15 units

Also, as a part of this change, we have implemented some automation steps to the review process to assist with quicker turnaround times.

Please note the automation piece of this change will only take place on prior authorization requests submitted with an individual provider number. Requests submitted with a group number will not process through any of the automation steps.

4/25/22 Ending Coverage for G0396 and G0397

Provider Types: 08, 09, 10, 11, 31, 52, 53

Effective May 1, 2022, OHCA will no longer cover codes G0396 and G0397 when used for screening alcohol and substance use with brief intervention.

OHCA will continue to cover CPT 99408 for this important service.

4/22/22 COVID-19 Booster Vaccine Effective March 29, 2022, OHCA opened coverage for the following COVID-19 booster dose-specific vaccine and administration when used in accordance with the emergency use authorization (EUA) from the FDA:

  • 91309 – Moderna COVID-19 booster dose-specific vaccine
  • 0094A – Moderna COVID-19 vaccine administration – booster dose
4/20/22 Medical Prior Authorizations Webinar

The Oklahoma Health Care Authority is presenting a webinar for SoonerCare providers on Thursday, May 26 to provide instruction on the prior authorization process for medical services.

It will include member and procedure verification steps and a demonstration of a prior authorization submission using the secure provider portal.

Note: This webinar does not contain information on using InterQual review and is not recommended for behavioral health, dental or waiver providers.

Target Audience: SoonerCare providers and staff who submit authorization requests for medical services.

Visit the OHCA Provider Training page to register for the Medical Prior Authorizations webinar on Thursday, May 26 from 2 p.m. to 3:30 p.m.

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.

4/20/22 Public Health Emergency Extension

The Secretary of Health and Human Services announced the COVID-19 public health emergency (PHE) has been extended for 90 days, effective April 16, 2022. The extension allows certain Oklahomans on Medicaid who have become ineligible to maintain their health coverage over the next 90 days.

We are currently asking all members to update their contact information, as well as reaching out to those members at risk of being ineligible due to missing information. If you speak to a member with questions about the PHE or their SoonerCare status, please encourage them to do the following:

  • Make sure their contact information and documentation are updated by asking them to log in to mysoonercare.org. If they have any issues with their account, they can call the SoonerCare helpline at 800-987-7767.
  • Respond to requests for information. If members have received a letter from OHCA requesting information, they need to respond immediately.
4/14/22 Patient Centered Medical Home (PCMH) Behavioral Health Screening and Mock Audit Opportunity

Provider Types/Specialties: 08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093 

This webinar will review behavioral health screening requirements for SoonerCare Choice patient-centered medical home providers.

This presentation provides information about approved behavioral health screening tools, coding guidance, best practices, and offers behavioral health resources for PCMH providers. A brief update on the PCMH redesign, including information on the opportunity to register and participate in a PCMH mock audit, will be provided.

Target Audience: SoonerCare Choice patient-centered medical home providers. This presentation is not intended for contracted behavioral health providers.

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org.

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.

4/14/22 Changes with Electronic Remittances Advice (ERA)

Provider Types: All

This is to inform you of changes that will take place within the Electronic Remittances Advice (ERA).

After the implementation of ClaimXTen, providers noticed changes to the way their claims were processed versus information submitted on the claim.

For example: a provider submitted an incorrect procedure code based on age/gender of a member. Instead of the claim denying for incorrect procedure code, ClaimXTen will deny the line and zero out the billed amount for that code but will add another claim line with a more appropriate procedure code and the previous billed amount.

Currently, the ERAs do not show the zero-dollar amount on the original denied detail line but, going forward, the HIPAA remark codes for ClaimXTen EOB’s will display a zero-dollar amount, regardless of the amount billed.

4/12/22 Reminder for SoonerCare Provider Town Hall

Reminder for SoonerCare Provider Town Hall

Provider Types/Specialties: 01, 08/080-082, 086, 184, 193, 199, 208; 09; 10; 05; 03; 11; 23-25; 27; 31; 53

The Oklahoma Health Care Authority is hosting a town hall for all SoonerCare providers to gain feedback on the Comprehensive Quality Strategy (CQS). The CQS aims to make health care services better for your patients and community.

Discussion topics will include:

  • Social determinants of health
  • Decreasing obesity
  • Decreasing smoking, other tobacco use and vaping
  • Teen pregnancy

The town hall will be held virtually on Thursday, April 14 from 8 a.m. – 4 p.m.

Click here to register.

4/8/22 Prior Authorization Amendment Changes

Provider Types/Specialties: All (except 11 & 27)

To streamline the amendment process, the Medical Authorization Unit is implementing a change in the submittal of amendment requests.

Effective immediately, providers can now submit their amendment requests through the secure provider portal. Please see Prior Authorization Amendment Process for step-by-step instructions.

The faxed option will be discontinued and faxes for PA amendments will no longer be accepted effective May 1, 2022.

3/30/22 Chiropractors and SoonerCare Webinar

Provider Types/Specialties: 15, 08/187

The Oklahoma Health Care Authority is presenting a webinar for chiropractors on Thursday, April 21 that will provide information about the SoonerCare provider contract process and includes helpful resources for providing Oklahoma Medicaid services.

Target Audience: Chiropractors providing alternative treatments for pain management to SoonerCare adults.

Visit the OHCA Provider Training page to register to attend the Chiropractors and SoonerCare webinar on Thursday, April 21 from 2 p.m. to 3:30 p.m.

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.

3/29/22 Contracts Expiring March 31, 2022

Provider Types/Specialties: 26/260, 23/230, 20/200, 17/170, 17/171, 17/173, 14/140

The following contracts expire March 31, 2022: ambulance services, dietician, audiologist, occupation/physical/speech therapist and podiatrist.

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”.

Additionally, 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 e-mail providerenrollment@okhca.org.

3/29/22 Percutaneous Transcatheter Closure of the Left Atrial Appendage with Endocardial Implant CPT 33340

Provider Types/Specialties: 011, 014, 312, 313, 341, 342

Effective March 1, 2022, OHCA is adding coverage for CPT 33340 - Percutaneous Transcatheter Closure of the Left Atrial Appendage with Endocardial Implant for ages 18 and older.

Prior authorization is required for this service.

3/25/22 Survey of Oklahoma Sickle Cell Health Care Providers

Provider Types/Specialties:  All

Dear health care provider to Oklahomans living with sickle cell disease:

In 2021, the Oklahoma State Department of Health (OSDH) awarded funding to Supporters of Families with Sickle Cell Disease, Inc. to measure the current status of sickle cell care in Oklahoma.

This survey is being conducted to understand the challenges health care professionals face in Oklahoma when caring for individuals and their families who live with the lifelong challenges of effectively managing sickle cell disease (SCD).

OSDH has established a diverse committee to review the findings of the SCD needs assessment and explore solutions to address gaps in knowledge about SCD best practices related to medical treatment and community-based wraparound support services.

Supporters of Families with Sickle Cell Disease is a nonprofit organization that is working to address the complex health, psychosocial and economic needs of individuals and families impacted by SCD by providing culturally sensitive health education, care coordination and community-based support services.

Results of this survey will be reported in summary form without revealing any personal identification information of the respondents. All individual survey data will be kept strictly confidential and will not be shared with anyone or any organization.

Please complete this SCD needs assessment survey no later than April 15, 2022. It should take less than five minutes to complete. If you have any questions about completing the survey, please call 918-619-6174 for assistance.

Survey link: https://corexms4rwq6fk59vz3v.qualtrics.com/jfe/form/SV_agADw6BKVyBrbmK.

Thank you for your time and professional input.

3/25/22 New Codes to Report Underimmunization for COVID-19 Status

Providers: All

Effective April 1, 2022, CMS has developed two new diagnosis codes to report underimmunization for COVID-19 status

  • Code Z28.310, Unvaccinated for COVID-19, may be assigned when the patient has not received at least one dose of any COVID-19 vaccine.
  • Code Z28.311, Partially vaccinated for COVID-19, may be assigned when the patient has received at least one dose of a multi-dose COVID-19 vaccine regimen, but has not received the full set of doses necessary to meet the Centers for Disease Control and Prevention (CDC) definition of “fully vaccinated” at the time of the encounter.

When providers are reporting CPT 99401 to report COVID-19 vaccine counseling for children ages 0-20, they should now also bill with either of these new applicable diagnosis codes.

More information on COVID-19 vaccines can be found on the CDC website at the following link: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/

3/21/22 Claim Processing Updates for Outpatient Facilities

The Oklahoma Health Care Authority is presenting a webinar for providers on Thursday, April 28 and Thursday, May 5 that will cover the integration of ClaimsXten™ software into the MMIS claims processing system for Outpatient Facility claims in support of the National Correct Coding Initiative (NCCI).

Target Audience: SoonerCare providers and staff that bill outpatient claims on a UB-04 claim type.

Visit the OHCA Provider Training page to register to attend the Claim Processing Updates for Outpatient Facilities webinar on Thursday, April 28, 2022 from 2 p.m. to 3:30 p.m. or on Thursday, May 5, 2022 from 2 p.m. to 3:30 p.m.

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.

3/17/22 SoonerCare Provider Town Hall

The Oklahoma Health Care Authority is hosting a town hall for all SoonerCare providers to gain feedback on the Comprehensive Quality Strategy (CQS). The CQS aims to make health care services better for your patients and community.

Discussion topics will include:

  • Social determinants of health
  • Decreasing obesity
  • Decreasing smoking, other tobacco use and vaping
  • Teen pregnancy

The town hall will be held virtually on Thursday, April 14 from 8 a.m. – 4 p.m. 

Click here to register.

3/17/22 Additional Dental Codes for Adults

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

Effective July 1, 2021, the following five codes have been added to the Adult Limited Dental Benefit: D0210, D7310, D7471, D7472, and D7473.

Please refer to the Dental Fee Schedule for more information. Medical necessity must always be documented in the members’ records and timely filing applies.

Please contact DentalServices@okhca.org with any questions.

3/10/22 Changes to Provider Action Form for PCMH (SC-13)

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

Effective March 10, 2022, OHCA will no longer accept the SC-13 Provider Action Form from primary care providers (PCPs) to override age restrictions on a PCP panel. SC-13 forms are for PCPs to enroll a member to their panel and override their current capacity. Please make sure you review your panel size and age restriction prior to this change.

 

Reasons for submitting an action form include:

• Adding an immediate family member of an established patient when the panel is at capacity.

• Adding an established patient when the panel is at capacity.

 

PCP change requests for all other reasons must be initiated online at www.mysoonercare.org or by calling the SoonerCare helpline at 800-987-7767.

 

3/9/22 Introduction to SoonerCare Webinar

Provider Types/Specialties: All

The Oklahoma Health Care Authority is presenting a webinar for providers that will give a high-level overview of Oklahoma Medicaid, known as SoonerCare.

This webinar will review SoonerCare eligibility requirements, programs, benefits available to members, and information about getting started as a SoonerCare provider.

Target Audience: Providers and staff who are new to SoonerCare.

Visit the OHCA Provider Training page to register to attend the Introduction to SoonerCare webinar on Thursday, April 14, 2022, from 2 p.m. to 3:30 p.m.

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.

3/1/22 Digital Breast Tomosynthesis CPT 77063 HCPCS G0279

Provider Types/Specialties:  01, 08, 09, 10, 16, 29, 31, 52

Effective March 1, 2022, OHCA is adding coverage for Digital Breast Tomosynthesis (3D mammogram) for ages 10 and older.  The appropriate codes to use when billing for this service are as follows:

  • 77063 -  screening digital breast tomosynthesis, bilateral (add-on code to 77067 – screening mammogram).  Prior authorization is required for ages 10-24.
  • G0279 – diagnostic digital breast tomosynthesis, unilateral or bilateral (add-on code to 77065/77066 – unilateral or bilateral diagnostic mammogram).  No prior authorization required for any ages.
3/1/22 Provider Letter 2022-03 RE: SoonerCare Choice Program Changes

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

As a part of ongoing efforts to innovate the SoonerCare Choice Patient-Centered Medical Home (PCMH) program, Oklahoma Health Care Authority will be implementing multiple changes throughout the 2022 calendar year related to medical home agreement requirements, QA SoonerCare Choice compliance reviews and tier requirements. Please reference Provider Letter 2022-03 for more information about the changes.

3/1/22 SoonerCare Provider Contracts Webinar

Provider Types/Specialties: All

OHCA will present a webinar titled SoonerCare Provider Contracts on Wednesday, Mar. 2, 2022, at 2 p.m.

This webinar is a comprehensive overview of OHCA’s SoonerCare provider enrollment process with information on new contracts and contract renewals, and helpful tips for efficiency and accuracy.

Target Audience: all Oklahoma Medicaid providers and staff.

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.

3/1/22 COVID-19 Vaccine Counseling

Provider Types: All

Effective 4/1/2021, OHCA will reimburse for COVID-19 vaccine counseling to and for the benefit of SoonerCare members ages 0-20 using CPT 99401 – preventive medicine counseling, typically 15 minutes.  The claim line for 99401 must include the ICD-10 diagnosis code Z71.89 (other specified counseling) and the CR modifier. The service will not be separately reimbursable when performed the same day as a COVID-19 vaccine administration as those codes already include counseling.

A counseling visit is a conversation between a provider and a patient, parent or guardian about the COVID-19 vaccine. Conversations may include topics such as patient’s reasons for not being vaccinated, addressing concerns identified by the patient, providing tailored and individualized medical advice regarding COVID-19 vaccine for that patient, and providing resources about how to get a COVID-19 vaccine if applicable. Counseling visits should be documented in a patient’s medical record according to standard documentation guidelines. It would not be appropriate to bill for this additional service just for checking vaccination status.

3/1/22 COVID-19 Diagnoses

Provider Types: All

Providers are reminded there are no copays when providing COVID-19-related services to SoonerCare members.

When providing a COVID-19-related service, providers should include one of the following diagnoses on their claim (when appropriate):

  • U071 – 2019 Novel Coronavirus
  • U099 – Post COVID-19 condition, unspecified
  • J1282 – Pneumonia Due to Coronavirus 2019
  • M3581 – Multisystem Inflammatory Syndrome
  • M3589 – Other Specified Systemic Involvement of Connective Tissue
  • Z1152 – Encounter for Screening for COVID-19
  • Z20822 – Contact with and Suspected Exposure to COVID-19
  • Z23 – Encounter for Immunization
  • Z8616 – Personal History of COVID-19

For any questions regarding COVID-19-related copay or billing issues, please call the OHCA provider helpline at 800-522-0114.

2/24/22 Nursing Facility Pay for Performance (PFP) Payment Update

Provider Types/Specialties:  03/30, 35

SFY2022 3rd Quarter PFP payment will be made on Feb. 23, 2022.

We thank you for your continued service to SoonerCare members.

2/17/22 COVID-19 Test Kit Reimbursement
OHCA is now reimbursing pharmacies for over the counter COVID-19 test kits. Reimbursement will be paid to contracted pharmacies that dispense the test kits to a SoonerCare member. COVID-19 test kits do not count against a member’s monthly prescription limit and there is no copayment. 
2/11/22 Dental Prior Authorization Requests Cancelled for Missing Documentation

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

Due to the high volume of dental prior authorization requests, any request not containing all necessary documentation will be cancelled. This change is effective immediately.

Please refer to OHCA policy for necessary documentation.

2/9/22 2022 Patient Centered Medical Home (PCMH) Redesign Webinar

Provider Types/Specialties:  08/080, 081, 082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093

OHCA will present a webinar titled 2022 Patient Centered Medical Home (PCMH) Redesign on Tuesday, March 8 at 2 p.m. and Thursday, March 24 at 2 p.m.

This webinar will provide an overview of the SoonerCare Choice compliance review and tier requirement changes effective Jan. 1, 2023. Attendees will learn more about the opportunity to participate in mock audits, provider engagement process changes and SoonerCare Choice website updates.

Target Audience: Current and prospective patient-centered medical home providers and staff.

OHCA welcomes your feedback and suggestions on the upcoming changes. Please feel free to send comments and questions to medhomecomments@okhca.org

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.

2/9/22 Appropriate Use of Modifier 91 for Laboratory Billing

Provider Types/Specialties: 28

OHCA would like to remind laboratory providers of the proper use of modifier 91, repeat clinical diagnostic laboratory testing.

Modifier 91 is used to report repeat laboratory tests or studies performed on the same day on the same patient. This modifier is added only when additional test results are to be obtained subsequent to the initial administration or performance of the test(s) on the same day.

It is not used when laboratory tests or studies are simply rerun because of specimen or equipment error or malfunction. Nor is it to be used when a test is repeated to confirm initial test results.

Furthermore, based on the definition of modifier 91, it should not be reported when the basic procedure code(s) indicate that a series of tests are to be obtained.

More information on the appropriate use of modifier 91 can be found at the following link: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144503#:~:text=Print-,Modifier%2091,Lab%20services%20examples%3A,-Line%201%20%3D%2084132

2/1/22 Referral Required Claim Edit

Claims for Expansion Adults enrolled in the SoonerCare Choice program that denied for no PCP referral for dates of service prior to Jan. 1, 2022, may be resubmitted for consideration of payment. 

 

A referral guide is available on the OHCA provider training page at https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/training/2021/Referral%20Guide.pdf

1/28/22 Over the Counter Covid Test Kits

Provider Types/Specialties:  All

OHCA is now reimbursing pharmacies for over the counter COVID-19 test kits. Reimbursement will be paid to contracted pharmacies that dispense the test kits to a SoonerCare member. COVID-19 test kits do not count against a member’s monthly prescription limit and there is no copayment.

For more information, please visit https://oklahoma.gov/ohca/providers/types/pharmacy/pharmacy-updates.html.    

1/28/22 Provider Letter 2022-01 Re: Vaccination Requirements

Provider Types: All

Provider Letter 2022-01 was sent on Jan. 25, 2022.

It describes the CMS rule regarding COVID-19 vaccination requirements for Medicare/Medicaid certified facilities and enforcement of the rule by the Oklahoma State Department of Health.

View Provider Letter 2022-01 here.

1/26/22 Care Management Provider Survey

Provider Types: All

OHCA is encouraging providers to complete a brief questionnaire so we may assess and increase provider awareness of care coordination services available to members with higher levels of social and health care needs.

Please follow this link to participate in the Care Management Provider Survey.

Thank you for your participation and passion to serve SoonerCare members.

1/25/22 Public Health Emergency Extension

The US Dept. of Health and Human Services has extended the public health emergency (PHE) declaration for 90 days. It is now scheduled to end April 16, 2022. The PHE renewal is posted here.

What does this mean for SoonerCare providers and members?

  • Expanded use of telehealth services for most SoonerCare services during the time the PHE declaration is in effect.
  • OHCA and DHS will not terminate SoonerCare coverage for members during the time the PHE declaration is in effect.
  • No cost sharing for testing or treatment of COVID-19 for SoonerCare members during the time the PHE declaration is in effect.
  • Some medicines may be prescribed for 90 days to reduce trips to the pharmacy during the time the PHE declaration is in effect.
1/20/22 SoonerCare Provider Contracts Webinar

Provider Types/Specialties: All

OHCA will present a webinar titled SoonerCare Provider Contracts on Tuesday, Feb. 22, 2022, at 2 p.m.

This webinar is a comprehensive overview of OHCA’s SoonerCare provider enrollment process with information on new contracts and contract renewals, and helpful tips for efficiency and accuracy.

Target Audience:  all Oklahoma Medicaid providers and staff.

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.

1/19/22 Eligibility in regard to Prior Authorizations

Provider Types/Specialties:  08/081, 082, 086; 27/270-279

This message serves as a reminder that providers are responsible for checking member eligibility. Prior authorization end dates are generally set at six months from date of authorization. If a member should lose eligibility before that date, and a claim is made for a service after loss of eligibility, the claim will not pay. Please be diligent in checking eligibility before providing services.

1/19/22

COVID-19 Treatments

Providers: All

OHCA covers the following COVID-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA:

  • 91300 - Pfizer BioNTech COVID-19 vaccine
    • 0001A - Pfizer BioNTech COVID-19 vaccine administration, first dose
    • 0002A - Pfizer BioNTech COVID-19 vaccine administration, second dose
    • 0003A - Pfizer BioNTech COVID-19 vaccine administration, third dose
    • 0004A - Pfizer BioNTech COVID-19 vaccine administration, booster dose
       
  • 91301 - Moderna COVID-19 vaccine
    • 0011A - Moderna COVID-19 vaccine administration, first dose
    • 0012A - Moderna COVID-19 vaccine administration, second dose
    • 0013A - Moderna COVID-19 vaccine administration, third dose
       
  • 91303 - Johnson & Johnson/Janssen COVID-19 vaccine
    • 0031A - Johnson & Johnson/Janssen COVID-19 vaccine administration, first dose
    • 0034A - Johnson & Johnson/Janssen COVID-19 vaccine administration, booster dose

  • 91306 - Moderna COVID-19 vaccine low dose
    • 0064A - Moderna COVID-19 vaccine (low dose) administration, booster dose

  • 91307 - Pfizer BioNTech COVID-19 pediatric vaccine
    • 0071A - Pfizer BioNTech COVID-19 pediatric vaccine administration, first dose
    • 0072A - Pfizer BioNTech COVID-19 pediatric vaccine administration, second dose

  • M0201 - COVID-19 vaccine home administration


OHCA covers the following COVID-19 monoclonal antibodies and administration when used in accordance with the emergency use authorization (EUA) from the FDA. Monoclonal antibody infusion is reimbursable when provided in a hospital outpatient department or physician’s office experienced in infusion services. Due to the risk of anaphylaxis, treatment should only be administered in settings where health care providers have immediate access to medications to treat a severe infusion reaction and the ability to activate the emergency medical system as needed.

  • Q0243 – Injection, casirivimab and imdevimab, 2400 mg (Regeneron), first dose

  • Q0244 – Injection, casirivimab and imdevimab, 1200 mg (Regeneron), first dose
    • M0243 – Intravenous infusion or subcutaneous injection, casirivimab and imdevimab 2400 mg or 1200 mg, infusion or injection, and post administration monitoring (Regeneron), first dose
       
  • Q0240 – Injection, casirivimab and imdevimab, 600 mg (Regeneron), subsequent or repeat doses
    • M0240 – Intravenous infusion or subcutaneous injection, casirivimab and imdevimab 600 mg, includes infusion or injection and post administration monitoring (Regeneron), subsequent or repeat doses
       
  • Q0245 – Injection, bamlanivimab and etesevimab, 2100 mg
    • M0245 – Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring
       
  • Q0247 – Injection, sotrovimab, 500 mg
    • M0247 – Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
       
  • Q0249 – Injection, tocilizumab, 1 mg
    • M0249 – Intravenous infusion, tocilizumab, includes infusion and post administration monitoring, first dose
    • M0250 - Intravenous infusion, tocilizumab, includes infusion and post administration monitoring, second dose

OHCA also covers Evusheld (tixagevimab co-packaged with cilgavimab) for the pre-exposure prophylaxis of COVID-19 for adults and pediatric members 12 years of age and older (weighing at least 40kg) with no known COVID-19 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).    

  • Q0220 – Injection, tixagevimab 150 mg and cilgavimab 150 mg
    • M0220 - Injection, tixagevimab and cilgavimab, includes injection and post administration monitoring.
1/19/22 Acute Hospital Care at Home

Provider Types: 01

As a reminder, inpatient facilities can apply through CMS for the ability to provide some inpatient services to patients in their home. Each facility must apply individually. Additional information can be found at https://qualitynet.cms.gov/acute-hospital-care-at-home.

1/14/22 Long-Acting Reversible Contraceptives in an FQHC

Provider Types/Specialties:  08/080

Effective Dec. 30, 2021, OHCA will allow reimbursement for long-acting reversible contraceptives (LARC) in addition to the FQHC encounter rate. 

The compensation for the LARC will be at the current fee-for-service rate.

Please view Provider Reimbursement Notice 2022-01 for more information.

1/11/22 Modifier 25 and 59 Medical Review Bypass Code Lists

OHCA has provided a list of procedure codes that do not require documentation review when billed with modifier 59 to indicate a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day.

Likewise, OHCA has also provided a list of E/M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes to indicate a significant separately identifiable service was performed on the same day.   

Both these lists and other information regarding NCCI edits can be found on the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html.

1/10/22 C-Section Rate Letters

Provider Types: 1, 8, 31, 52

The year-end C-section rate letters for state fiscal year 2021 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.

1/7/22 Member Demographic Change Process

Provider Types/Specialties:  All

Beginning February 1, 2022, OHCA will no longer accept Member ID Correction forms. Providers should contact the SoonerCare Helpline at 800-987-7767 to report any member demographic changes. Agency Partners should contact the number above and then select option 4 and enter their PIN to access the Agency Partner Helpline. 

1/7/22 PT/OT/ST Developmental Testing

Provider Specialties: 087, 170, 171, 173, 182

Effective Feb. 1, 2022, OHCA will no longer separately reimburse for developmental testing performed by physical therapists, occupational therapists or speech therapists utilizing CPT codes 96112 and 96113.

Codes used to bill therapy evaluation services already include reimbursement for any testing that may be required to develop a therapy treatment plan.  

CPT 96112 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour  

CPT 96113 - developmental test administration, (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; each additional 30 minutes   

1/7/22 Soon-to-be-Sooners Limited Dental Benefits

Provider Types/Specialties:  08/081, 086; 27/271, 272, 274, 275

Effective Jan. 1, 2022, Soon-to-be-Sooner members (STBS/STBS-M) are eligible for limited dental benefits, which are necessary for the health and well-being of the unborn child during pregnancy and birth. Providers will be compensated for providing the following dental codes when medically necessary.

  • D1110 Prophylaxis
  • D1206 Fluoride varnish
  • D4346 Scaling in presence of inflammation
  • D4342 Scaling and root planing 1-3 teeth/quadrant
  • D4341 Scaling and root planing 4 or more teeth/quadrant
  • D7140 Extraction erupted tooth
  • D7210 Extraction erupted tooth
  • D0120 Periodic oral evaluation
  • D0140 Limited oral evaluation
  • D0150 Comprehensive oral evaluation
  • D0220 Intraoral – periapical first radiographic image
  • D0230 Intraoral – periapical each additional radiographic images
  • D0272 Bitewing – two radiographic images
  • D0274 Bitewing – four radiographic images
1/3/2022 SoonerCare Choice Referrals Webinar

Provider Types/Specialties: All

OHCA will present a webinar titled SoonerCare Choice Referrals on Thursday, Feb. 10, 2022, at 2 p.m. and Thursday, Feb. 24, 2022, at 2: p.m.

This class will discuss the SoonerCare Choice referral guidelines for members enrolled with a patient-centered medical home provider and provide instructions on administrative referral requirements.

Note: Referrals submitted through the OHCA secure provider portal by I/T/U providers to specialists will not be covered.

Target Audience: SoonerCare Choice primary care providers and medical homes who issue referrals and specialists who receive referrals.

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.

 

Last Modified on Jun 30, 2022