Global Messages

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2018 Global Messages
2017 Global Messages
2016 Global Messages
2015 Global Messages
2014 Global Messages
2013 Global Messages
2012 Global Messages
2011 Global Messages
2010 Global Messages
2009 Global Messages
2008 Global Messages
2007 Global Messages
2006 Global Messages  

 

Date Posted Title Message  
11/26/2019 Out of State Services Webinar OHCA and DXC will be presenting a webinar titled “What’s New in Out-of-State Services” on Tuesday, Dec. 3 at 2:30 p.m. This is for providers who may request out-of-state services (MD, DO, APRN, PA), or specialists to whom referrals may be made to evaluate for out-of-state services.


The webinar will cover important changes in federal regulations and state rules that have resulted in SoonerCare policy modifications for out-of-state services. All three types of existing out-of-state services will be reviewed, and new changes will be presented.

Register here to attend the “What’s New in Out-of-State Services” webinar: https://okhca.org/xwebinars.aspx.

11/22/2019
Dear Provider Letter 2019-23 PV Specialties: 80, 81, 82, 84, 85, 88, 90, 92, 93, 100, 184, 185, 316, 318, 320, 322, 344, 345, 351, 359, 528, 801, 802

Provider Letter 2019-23 serves to inform providers about the availability of continuous glucose monitoring systems through pharmacies beginning Jan. 1, 2020. Please post all comments by close of business Wednesday, Dec. 18, 2019 via the Oklahoma Health Care Authority policy change blog. Thank you.
10/23/2019 Dear Provider Letter 2019-22 Provider Letter 2019-22 serves to inform providers that on November 1, 2019 the OHCA will be adding coverage to OAC 317:30-5-22.1. This will allow obstetricians and family practice physicians to request High Risk Obstetrical services without Maternal Fetal Medicine consultation; in appropriate cases. Please post all comments by close of business Friday, November 22, 2019, via the Oklahoma Health Care Authority Policy Change Blog. Thank you.
10/14/2019 Notice for Members to Contact the SoonerCare Helpline Provider Types: All

When checking member eligibility, if a red notice is displayed requesting to “Please have the member contact the SoonerCare Helpline at 800-987-7767”, we are asking that you please help us relay this important information to the member.

We would also appreciate your assistance in reminding members that they can login to their accounts at www.mysoonercare.org to read related messages and update their information 24/7.

Thank you for your assistance and support of SoonerCare. 
10/14/2019 Applied Behavior Analysis
Provider Type: 17 (Specialty Types: 176, 177, & 178)

CMS has approved the Applied Behavior Analysis State Plan Amendment request that was submitted on June 26, 2019. Effective Oct. 7, 2019, SoonerCare contracted Board Certified Behavior Analysts who have received prior authorization for ABA services, may submit or resubmit claims for payment of services rendered on July 1, 2019 and thereafter. Timely filing requirements must be met to receive reimbursement.

The Oklahoma Health Care Authority will be submitting a new SPA request to the Centers for Medicare & Medicaid Services to recognize Registered Behavior Technicians as an Oklahoma Medicaid provider type, and to allow for coverage of RBT services with a requested effective date of Jan. 1, 2020. Additionally, corresponding RBT agency rules must also be promulgated and receive approval by the Governor before OHCA can begin coverage of and reimbursement for ABA services provided by RBTs. No claims can be billed under the 97153 RBT CPT code until the SPA and the agency rules are approved.

All RBTs interested in providing compensable ABA services to SoonerCare members under age 21 are required to apply and be approved for a provider contract with OHCA. Interested RBTs can begin enrolling as a SoonerCare RBT provider on Nov. 18, 2019; the contract’s effective date will be Jan. 1, 2020.  Individuals may apply by completing the RBT application. In order to complete your application, you will be required to upload a copy of your national RBT certification. RBTs must work under the supervision of a SoonerCare contracted BCBA.  Please note, if you are currently contracted with OHCA to provide other compensable services to SoonerCare members, you will be required to have a separate contract for ABA services. To begin enrollment, please access the following link: https://www.ohcaprovider.com/Enrollment/(S(dpch43qo4ndvkoprsvpysme2))/Site/Home/createuser.aspx

If you have any questions regarding contracting, please call 800-522-0114, option 5, or email ProviderEnrollment@okhca.org, to receive assistance.

10/14/2019 C-Section Rate Letters
Provider Types:  03/30, 31, 32, 33, 34, 35.

The year-end C-section rate letters for state fiscal year 2019 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 http://www.okhca.org/c-section.

Thank you.
10/9/2019 ConnectFirst Program, a Community resource available to Tulsa County residents OHCA has partnered with ConnectFirst, a Tulsa County based program that supports healthy pregnancies, births and early childhood development. Pregnant women and parents of young children who are enrolled in SoonerCare can receive help at no cost from the ConnectFirst team, which includes Registered Nurses, family advocates, a lactation consultant, and other team members. Services include personalized support and connection to educational and community resources.

Families may enroll in the ConnectFirst program by calling 918-900-0808 or by visiting http://www.connectfirsttulsa.org/.
10/9/2019 Revenue Codes 0761-0762 Provider Types/Specialties: All Hospitals-010, 011, 012, 013, 014, 015, 016, 017, 018, 201, 204, 205

OHCA has implemented coverage effective July 1, 2019 for the Soon to be Sooners (STBS) and STBSM Programs for revenue codes 0761-Treatment Room and 0762-Observation Room. These revenue codes will be subject to medical review and will require medical or supporting documentation. Providers may resubmit previously denied claims for review for any dates of service July 1, 2019 and after. If any lines on the claim were paid, the claim should be voided prior to resubmission. Please see policy 317:30-5-42.11 for observation/treatment requirements.
10/8/2019 Long-Term Care Cost Reports SFY19 Provider Type:  03/30, 31, 32, 33, 34, 35
 
Long-term care provider cost reports for state fiscal year 2019 are due by Oct. 31, 2019.

Facilities may be subject to a rate reduction, equal to the amount of the direct care portion of the daily rate, ranging from $16.68 to $35.62 per patient day, if cost reports are not received in a timely manner.

Thank you for your attention to this matter.

10/4/2019 PCMH Redesign Planned for October 2020 – Additional Stakeholders Meetings Scheduled Provider Types: All

Based on provider suggestions collected in 2016 and 2017, OHCA is now prepared to bring a new value-based enhanced design to the providers in the Patient Centered Medical Home program (SoonerCare Choice, SoonerCare Choice ITUs and Insure Oklahoma Individual Plan). The new design will include increased care coordination payments along with performance measures that have been recommended by providers in previous workgroups. Providers will receive payments based on what they bring to the program, particularly integration with behavioral health services and social determinations/substance use disorder screening and referral. The anticipated start date is October 2020, dependent on CMS approval.

Our first Stakeholders webinar and in-person meeting was held on September 17th at 9:30 AM.  Additional stakeholders meeting are scheduled for October 22nd in Tulsa and October 23rd in Oklahoma City.  There is also an option to attend via webinar on October 23rd.  We will be providing additional details regarding the new design, answering questions and requesting your input. You can download the PowerPoint Presentation here.

Please register using the links below: 

Tulsa


Oklahoma City
10/2/2019 CPT Code 96110

Provider Types:  08, 10, 31, 52

This global message is sent to remind providers OHCA began reimbursing CPT code 96110 (developmental screening) in addition to any appropriate E&M codes billed on the same day by the same provider.  In 2019, CPT codes 96112 and 96113 were added in addition to CPT code 96110. 

It is recommended pediatric primary care providers use a standardized tool to screen infants and toddlers at 9, 18, 24 or 30 months. It is also recommended an Autism-specific screening be performed at 18 or 24 months based on the AAP Bright Futures latest edition.  The use of a standardized screening tool is also appropriate at other times if concerns are identified through routine surveillance or parental/caregiver concerns are raised.

Documentation of the screening must include the screening tool used, the results of the screen, any referrals needed or made, and follow up care or recommendations.  The screening documentation must be separate from documentation related to other services performed that day and must be appropriately signed by the rendering practitioner.

Thank you.

9/24/2019 Dear Provider Letter 2019-21 PV Types:  08, 09, 10, 24, 31, 52

Provider Letter 2019-21 serves to inform providers about the new prior authorization requirements for testosterone replacement therapy, effective October 23, 2019. Please post all comments by close of business Thursday, October 24, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you
9/19/2019 72X Mass Adjustment Provider type: 30

OHCA ran a mass adjustment for Medicare cross-over claims billed with type of bill 72X to correct co-insurance amounts which may result in less coinsurance paid. The dates of service affected were 09/01/2017 to present. The ICN for the adjustments begins with 5219253001 and will appear on your 9/18 remittance advice (RA) and could continue to your 9/25 RA. Contact the OHCA Adjustment unit at 1-800-522-0114 Option 3, then 1 if you have further questions regarding these adjustments.  

Thank you
9/10/2019 Dear Provider Letter 2019-20 PV Specialities: 112, 195, 329, 355, 356
 
Provider Letter 2019-20 serves to inform providers about the prior authorization for medications that are used to treat lymphoma, effective October 15, 2019. Please post all comments by close of business Thursday, October 17, 2019, via the Oklahoma Health Care Authority Policy Change Blog. Thank you.
9/10/2019 Dear Provider Letter 2019-19 PV Specialities: 01, 08, 09, 10, 11, 14, 17, 18, 27, 31, 52
 
Provider Letter 2019-19 serves to inform and educate providers about the new out-of-state services policy. Please post all comments by close of business Thursday, October 10, 2019, via the Oklahoma Health Care Authority Policy Change Blog. Thank you.
9/9/2019 Dear Provider Letter 2019-17 PV Specialities: 010
 
Provider Letter 2019-17 serves to inform providers about the no prior authorization requirement for psychiatric or medical detoxification services received in a non-psychiatric unit of a hospital for adults. Please post all comments by close of business Wednesday, October 9, 2019, via the Oklahoma Health Care Authority Policy Change Blog. Thank you.
9/6/2019 Adult and Pediatric Echocardiograms Provider Types/Specialties: 08, 09, 31, 52

Effective October 1, 2019, prior authorization requirements will be removed for adult and pediatric echocardiograms with CPT codes: 93303, 93304, 93306, 93307, and 93308.

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114.

Thank you.

9/6/2019 Age Extension for HPV Vaccination Provider Types/Specialties: 08, 09, 31, 52, 100

ACIP guidelines were updated effective August 16, 2019 to extend the age for vaccination for HPV (Gardasil 9), CPT 90651, for adults ages 27-45.  Coverage has been updated for TXIX members, Insure Oklahoma members and SoonerPlan members.
9/6/2019 PCMH Redesign October 2020 Stakeholder Input Requested Based on provider suggestions collected in 2016 and 2017, OHCA is now prepared to bring a new value-based enhanced design to the providers in the Patient Centered Medical Home program (SoonerCare Choice, SoonerCare Choice ITUs and Insure Oklahoma Individual Plan). The new design will include increased care coordination payments along with performance measures that have been recommended by providers in previous workgroups. Providers will receive payments based on what they bring to the program, particularly integration with behavioral health services and social determinations/substance use disorder screening and referral. The anticipated start date is October 2020, dependent on CMS approval.

This Stakeholders meeting will be held on September 17th at 9:30 AM. We will be providing additional details regarding the new design, answering questions and requesting your input.

You can attend in person at this location:

OHCA
Beavers Bend Conference Room
4345 N. Lincoln Blvd., OKC, OK 73015

Or to attend the meeting via webinar, please register here: https://okhca.zoom.us/webinar/register/WN_kwNSIP-jTmy1Se2vOYA_hg

An additional forum will be hosted in early October.

8/26/2019 Global Message for Provider Type 278 & 273 A friendly reminder for SoonerCare orthodontic providers:  When submitting documentation for orthodontics, providers will be reimbursed for either the study models or oral/facial images.
8/13/2019 New Dear Provider Letters     PV Specialties:  080, 081, 088, 090, 091, 092, 093, 100, 181, 184, 185, 194, 199, 280, 281, 312, 316, 318, 322, 328, 335, 344, 345, 349, 359, 525, 550

Provider Letter 2019-16 serves to clarify appropriate screening services for SoonerCare members. Please post all comments by close of business Thursday, September 12, 2019, via the Oklahoma Health Care Authority Policy Change Blog. Thank you.
7/31/2019 New Dear Provider Letters Provider Letters 2019-09 through 2019-15 outline OHCA program and policy updates that will become effective September 1, 2019.  For full details about these changes, please visit www.okhca.org/providerletters. Thank you.
7/31/2019 G0296 Coverage

Effective 8/1/2019, OHCA will add coverage for G0296 - counseling visit to discuss need for lung cancer screening using low dose computed tomography scan (LDCT) (service is for eligibility determination and shared decision making). This service is covered for ages 55-77 with a limit of one time per calendar year.

OHCA follows the Centers for Medicare and Medicaid (CMS) National Coverage Determination (NCD) requirements for this visit. CMS NCD 210.14

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have questions about this new coverage.

7/26/2019 Applied Behavior Analysis (ABA)

Pursuant to Oklahoma Administrative Code 317:30-3-65.12, effective July 1, 2019, all Board Certified Behavior Analysts (BCBAs) interested in providing compensable services to SoonerCare members ages 21 and younger are required to apply and be approved for a provider contract with the Oklahoma Healthcare Authority (OHCA). Individuals will apply by: accessing OHCA’s provider portal; selecting “Applied Behavior Analyst” as the provider type; and then selecting either Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA) as the specialty. In order to complete your application, you will be required to upload a copy of your national certification (licensed human services professionals), license or certificate issued by DHS on behalf of the Oklahoma Licensed Behavior Analyst Board (BCBAs, BCaBAs, and unlicensed human services professionals), and/or human services professional license (licensed human services professionals), if applicable. Please note, if you are currently contracted with OHCA to provide other compensable services to SoonerCare members, you will be required to have a separate contract for ABA services. To begin enrollment, please access the following link: https://www.ohcaprovider.com/Enrollment/(S(dpch43qo4ndvkoprsvpysme2))/Site/Home/createuser.aspx. If you have any questions regarding contracting, please call 1-800-522-0114 option 5, or email ProviderEnrollment@okhca.org, to receive assistance.

For further information regarding CPT codes, prior authorization, and location of ABA templates please visit the following link:
http://www.okhca.org/providers.aspx?id=23614

7/25/2019 Dear Provider Letter 2019-08

Provider Letter 2019-08 serves to inform providers about changes being made to prior authorization requirements for medication assisted treatment. Please post all comments by close of business Friday, August 23, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.  

7/16/2019 Dear Provider Letter 2019-07 Provider Letter 2019-07 serves to inform providers that, effective August 1, 2019, the Oklahoma Health Care Authority will no longer be backdating provider contracts prior to the date that the provider was screened. Please post all comments by close of business Thursday, August 15, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.
7/11/2019 Change In C-Section Rate Letters OHCA is notifying you that the C-section rates letters will be distributed on a semi-annual basis instead of quarterly. The improved process will provide cumulative calculations of the primary and total C-section rates effective July 1, 2019. For date of service 7/1/2019 – 12/31/2019, the rates will be available March 31, 2020 through the OHCA Provider Portal. For the SFY 2020 (date of service 7/1/2019 – 6/30/2020), the year-end rates will available September 30, 2020.

C-section rate letters for the third quarter of SFY 2019 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.

If you need help retrieving 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.

7/9/2019 Oklahoma Health Information Exchange Survey The State of Oklahoma is planning to release an open, deliverables-based request for proposal (RFP) for a single statewide health information exchange (HIE). The state will be seeking a vendor to manage the operations and technology to support the statewide exchange of clinical healthcare information and other services to support the improvement in health outcomes.

We are seeking your input into the values, functionality and services of the statewide HIE. The survey will be open for two (2) weeks beginning July 8, 2019.  Once closed, the results of this survey will be evaluated and released via state agency websites. 

Your response to this survey will aid the State in prioritizing the deliverables and in identifying the values that should be achieved as a result of this investment. The survey can be accessed by clicking this link.
6/27/2019 Current Mailing Address REQUIRED Webinar Provider Type/Specialty:  All provider types

OHCA and DXC will be presenting a webinar titled Current Mailing Address REQUIRED on Thursday, July 11th, July 25th and August 8th.  All of the webinars will begin at 2:00 p.m.  This webinar is applicable to all SoonerCare providers.

These webinars will cover information concerning amended and new OHCA rules that require SoonerCare members to keep their addresses up to date in order to have continued SoonerCare eligibility.  It will highlight outreach efforts that OHCA will be making to members whose mail has been returned to OHCA and how providers can assist in these efforts.

Register to attend one of the Current Mailing Address REQUIRED webinars: https://okhca.org/xwebinars.aspx.
5/30/2019 RE: Change in Billing for Supprelin® LA As authorized by OAC 317:30-5-77.2, effective July 1, 2019, the Oklahoma Health Care Authority (OHCA) will change the way Supprelin® LA for central precocious puberty is billed.

Supprelin® LA is only available through the medical benefit. The current billing code used is J9226. This code may change in the future based on guidance from the Centers for Medicare and Medicaid Services (CMS). It is the provider’s responsibility to assure codes used for billing are up to date and accurate.

Supprelin® LA continues to require a prior authorization (PA). The specific PA requirements for Supprelin® LA are below and can be located on the OHCA website at www.okhca.org/pa in the “Diabetes/Endocrine” therapeutic category. Use the PA form PHARM-18, which can be found on the OHCA website at www.okhca.org/rxforms.

An FDA approved diagnosis of central precocious puberty is confirmed by submitting the following:

  • Documentation of onset of symptoms <8 years of age in females and 9 years of age in males; AND
  • Documentation that bone age is advanced 1 year beyond the chronological age; AND
  • Lab assessment:
    • Documentation of abnormal basal gonadotropin levels; OR
    • Documentation of pubertal response to a gonadotropin-releasing hormone analog stimulation test; AND
     
  • Approvals may be granted with documentation of failed trials of lower-tiered products or an FDA approved indication not covered by a lower-tiered product, such as Lupron Depot-Ped® and Triptodur®.  

All medication PA requests are submitted to the Pharmacy Prior Authorization Unit at the fax number located at the bottom of the form. Do not submit the request to Medical Authorization Unit or via the provider portal.

If you have questions, please contact the Pharmacy Authorization Unit at (800) 522-0114, option 4.

5/23/2019 Coverage of Direct Resin-based Composite Restorations

Provider type: 27, Provider Specialty: 086, 271, 274, 278

Effective May 20, 2019, dental services for children will include coverage of CDT code D2394, resin-based composite- four or more surfaces, posterior.

For utilization parameters and coverage criteria for restorations, see OAC 317:30-5-699.

Payment is made for dental services set forth in this section.
5/8/2019 Information On The Appropriate Use of Modifiers

The Oklahoma Health Care Authority (OHCA) is providing the following links as a resource to assist Providers in the billing and use of appropriate modifiers, specifically modifiers 25 and 59.   

Novitas Modifier 25

Novitas Modifier 59

5/1/2019 Prostatic Urethral Lift Effective 05/01/2019, the Oklahoma Health Care Authority (OHCA) implemented coverage for the following codes for the Prostatic Urethral Lift:
  • 52441 – UroLift cystourethroscope first implant
  • 52442 – UroLift cystourethroscope each additional implant
The UroLift system is a minimally invasive treatment for benign prostatic enlargement with lower urinary tract symptoms.

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have any questions about this new coverage.
4/17/2019 C-Section Rate Letters

C-section rate letters, for the second quarter of state fiscal year 2019, are now available through the OHCA Provider Portal. As a reminder, these C-section letters are only available electronically.    

If you need help retrieving your letters, please call the Provider Helpline at 800-522-0114 for questions concerning the Portal.     

You may also view the C-section rate release schedule on the OHCA webpage at www.okhca.org/c-section.    

Thank you. 

3/6/2019 Skin Substitute Coverage Effective 02/15/2019, the Oklahoma Health Care Authority (OHCA) implemented coverage for the following skin substitute products:
  • Q4102—Oasis Wound Matrix 
  • Q4107—Graftjacket 
  • Q4132—Grafix Core 
  • Q4133—Grafix Prime 
  • Q4186—Epifix  

Skin substitute products will require prior authorization (PA) along with documentation supporting medical necessity (as outlined in the Oklahoma Administrative Code (OAC) 317:30-3-1). For your review, OHCA’s Wound Care and Skin Substitute guidelines are posted on our website under Medical Authorization Unit which outline specific indicators for use.

The OHCA expects that in cases in which there are multiple sizes of products available, the size that best fits the wound with the least amount of waste, at the LESSER cost, will be utilized.

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have any questions about this new coverage.

2/14/2019 CPT 87150 Reimbursement Change

Title: CPT 87150 Reimbursement Change

Effective February 15, 2019, the Oklahoma Health Care Authority (OHCA) will only reimburse for CPT 87150 (culture typing; identification by nucleic acid [DNA or RNA] probe, amplified probe technique, per culture or isolate, each organism probed) in the outpatient hospital setting.   

Please note: When this service is performed in the inpatient setting, reimbursement is included in the DRG payment.   

If you have questions about this change, please contact the OHCA Provider Helpline at 1-800-522-0114.

2/12/2019 Electronic Inpatient and Discharge Notifications

Title: Electronic Inpatient and Discharge Notifications

Inpatient admission and discharge letters are now available on the SoonerCare Provider Portal. You can find them under the Letters tab. Previously faxed, the inpatient admission and discharge letters are now only available electronically. This change only affects PCMH providers.

1/25/2019 Dear Provider Letter 2019-01

Title: Dear Provider Letter 2019-01

Provider Letter 2019-01 serves to inform providers about policy regarding laboratory and diagnostic testing. Please post all comments by close of business Monday, February 24, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.

1/22/2019 Vaccine Administration Documentation

TITLE: Vaccine Administration Documentation

The Oklahoma Health Care Authority routinely reviews medical records in association with other business processes. The reviewers have noticed a lack of required information pertaining to vaccine administration and would like to remind providers of the required medical record documentation as per the CDC and ACIP recommendations. This information can be found at https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html#documentation   

All vaccines administered should be fully documented in the patient’s permanent medical record. As per the requirements of the National Childhood Vaccine Injury Act and best practice, documentation should include the following:

  • date of administration 
  • vaccine manufacturer 
  • vaccine lot number 
  • name and title of person who administered vaccine and address of facility where permanent record will reside 
  • vaccine information statement (VIS) 
  • date on VIS 
  • date provided to patient or parent/guardian 
  • vaccine type (ACIP abbreviation) 
  • route 
  • dosage (volume) 
  • site 
  • document vaccine refusal 

Please contact the OHCA Provider Helpline at 1-800-522-0114 with any questions or concerns.  

1/17/2019 C-Section Rates Letters 

  TITLE: C-Section Rates Letters 

C-section rate letters for the first quarter of state fiscal year 2019 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,for the Provider Helpline. Choose option 1 for questions concerning the Portal.   

You may also view the C-section rate release schedule on the OHCA webpage at www.okhca.org/c-section.    

Thank you.