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317:35-15-14.Billing procedures for personal care
[Revised 09-01-17]    

Billing procedures for personal care services are contained in the Oklahoma Medicaid Management Information Systems (OKMMIS) Billing and Procedure Manual. Questions regarding billing procedures that cannot be resolved through a study of the manual are referred to the Oklahoma Health Care Authority (OHCA). Contractors for Personal Care bill on CMS-1500 claim form. OHCA provides instructions to an Individual personal care assistant (IPCA) contracted provider for completion of the claim at the time of the contractor orientation. The contracted provider submits a claim for each member. The contracted provider prepares claims for services provided and submits the claims to the fiscal agent responsible for ensuring claims were properly completed. All personal care contractors must have a unique provider number. New contracted providers are mailed the provider number after they are placed on the claims processing contractor's provider file. All services provided in the service recipients home, member's home including Personal Care and Nursing must be documented through the Electronic Visit Verification (EVV) system. Additionally, work completed in the provider's office is documented in the EVV system. The EVV system provides alternate backup solutions if the automated system is unavailable; however, in the event of an EVV system failure, the provider documents time in accordance with internal policy and procedures backup plan. This documentation is sufficient to account for both in-home and in-office services. The provider agency's backup procedures are only permitted when the EVV system is unavailable.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.