Global Messages

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2019 Global Messages
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
9/23/20 Caries Risk Assessment and Orthodontic Referral Forms Provider types/specialties: 270, 271, 272, 273, 274, 275, 276, 277, 278, 279

Please be aware OHCA has revised the Caries Risk Assessment (CRA) and the DEN-2 Orthodontic Referral Form.

The CRA now consists of two forms – 1) Ages 0-6 years and 2) Age 7 and older.The DEN-2 has been revised to include the NPI of the referring dental provider. A recent global message informed orthodontic providers that they are now required to add the referring dentist’s NPI on any D8080 claim.

All forms are listed on the OHCA public website.

9/18/20 PT, OT, Speech Services via Telehealth Effective Sept. 30, 2020, the automatic addition of the GT modifier to therapy prior authorization (PA) submissions will no longer be added to the requested telehealth services.

Therapy PA submissions requesting telehealth services will now require providers to submit telehealth services with the GT modifier and the therapy discipline modifier GN, GO, or GP.  

The therapy provider will need to submit two separate line items when requesting outpatient therapy services and telehealth therapy services; one line for outpatient therapy services and one line for telehealth services. The approved units for outpatient and telehealth are NOT interchangeable. Any changes to the usage of the approved units will require an amendment.

Therapy services that have already been prior approved for dates of service after Oct. 30, 2020 will require an amendment if the therapy services are to be done via telehealth.

If you have any questions, please call the OHCA provider helpline at 800-522-0114.

Thank you for your support of SoonerCare.

9/16/20 DME to Home Health project changes Provider Types: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, 52

Pursuant to the Global message sent 7/31/20, pricing changes for DME will be implemented September 17, 2020. All paid claims with dates of service on or after August 1, 2020 will be reprocessed and adjusted and will be reflected on claims run over the upcoming month.
9/8/20      Orthodontic claims for comprehensive services Effective Sept. 17, 2020, all orthodontic claims for comprehensive services (D8080) must include the referring dentist’s NPI on the dental claim. Claims will be denied if the referring NPI is not listed on the claim.

317:30-5-700. Orthodontic services

[Revised 09-01-16]

(a)    In order to be eligible for SoonerCare Orthodontic services, members must be referred through a primary care dentist; a member can receive a referral from a primary care dentist to the orthodontist.

 
9/1/20 OHCA Website and Provider's Self-help Tools OHCA and DXC will be presenting a webinar titled OHCA Website and Provider’s Self-help Tools on Thursday, Sept. 10 at 2 p.m. and again on Tuesday, Sept. 22 at 2 p.m. This webinar is for all SoonerCare provider types and billing staff. Discover the resources available to providers on the OHCA public website (www.okhca.org). This class is an overview of navigating the OHCA public site. We will focus our attention on highlighting educational tools for our provider's offices such as where to find billing manuals, policy information, subject-specific PowerPoints, forms and more.

Note: the OHCA public website will be covered in this class (www.okhca.org), NOT the SoonerCare Provider Portal.

Register to attend the OHCA Website and Provider’s Self-help Tools webinar on either Sept. 10 or Sept. 22 here.
8/28/20 C-Section Rate Letters Provider types/specialties: 01, 08, 31, 52

C-section rate letters for the first six months (July – December) of state fiscal year 2020 are now available through the OHCA Provider Portal.

If you need help to retrieve 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.  
8/24/20 New Dear Provider Letters Provider types/specialties: All

Provider Letters 2020-05 through 2020-14 outline OHCA program and policy updates that will become effective Sept. 14, 2020 or Nov. 1, 2020.  For full details about these changes, please visit  www.okhca.org/providerletters. Thank you.  
8/20/20 Nursing Facility Pay for Performance (PFP) Payment Update Provider types/specialities: 03/30, 35

SFY 2021 first quarter PFP payment will be made on Aug. 26, 2020.

We thank you for your continued services to SoonerCare members. 
8/19/20 Caries Risk Assessment Form Provider types/specialties: 27, 270, 271, 272, 273, 27, 275, 276, 277, 278

Updated OHCA Caries Risk Assessment forms can be found on our website. Please utilize the updated forms whenever submitting for any prior authorization. Forms must be completed entirely and include both the provider and parent or guardian signatures.
8/11/20 Provider Relief Fund: New Applications Being Accepted

HHS announced that eligible providers would be given another opportunity to submit their application for funds from the Provider Relief Fund. Examples of eligible Medicare, Medicaid, CHIP and dental providers include:

  1. Providers who did not receive an initial payment that totals approximately 2% of their annual patient revenue.
  2. Providers who did receive an initial payment but missed the June 3 deadline to submit their revenue information.
  3. Providers who were ineligible for prior General Distribution funds due to a change in ownership or because they did not have Medicare fee-for-service revenue in 2019.
  4. Providers who previously received Phase 1 General Distribution payment(s) but rejected and returned the funds and are now interested in reapplying.

The deadline for applying for funds is Aug. 28, 2020.

For the latest information on the Provider Relief Fund Program, visit: hhs.gov/providerrelief

Read the press release here: https://www.hhs.gov/about/news/2020/08/10/hhs-provider-relief-fund-phase-2-general-distribution-now-accepting-additional-applicants.html.

8/7/20 Sleep Study Codes in InterQual Provider Types: 01, 08, 09, 10, 16, 29, 31, 52

Effective Aug. 1, 2020, OHCA will open coverage of sleep studies for adults and will implement sleep study codes to run through InterQual guidelines that are embedded into the SoonerCare provider portal prior authorization function. Providers will now need to answer questions in InterQual and submit supporting documents. The use of InterQual guidelines began on Jan. 1, 2018. For details, refer to provider letter 2017-35 and 2017 Global Message dated Oct. 10, 2017, “Upcoming Changes to the Medical Authorization Prior Authorization Process.”. Home sleep studies codes 95800 and 95806 will also be opened for coverage for ages 21 and older through InterQual. The following requirements for reimbursement must be met:

  1. The home sleep study must be provided by a Sleep Diagnostic Testing Facility (“Facility”) as defined in Section 7200.3(6) of Title 63 of the Oklahoma Statutes;
  2. The home sleep study must be performed with a technically adequate device;
  3. The Facility must have a supervising or an interpreting physician, a registered sleep technician or a licensed respiratory therapist specifically trained in the use of home study equipment, provide the member with face-to-face instructions in the correct use of the equipment; and
  4. The Facility providing the study must provide 24-hour telephone support by a registered sleep technician or licensed respiratory therapist specifically trained in the use of home-study equipment.
 
8/4/20 Provider Check Application Status link Provider Types: All

Effective Aug. 3, 2020, providers will be able to check their contract application status with Oklahoma Health Care Authority through a link on the public website. The Check Application Status link can be found at www.okhca.org under the contracts section of the enrollment page. The application tracking number (ATN) and the FEIN or SSN from the contract will be required to access the information. If you have questions or need assistance, please call the provider helpline at 800-522-0114 or email providerenrollment@okhca.org.

7/31/20 DME to Home Health project changes Provider Types: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, 52

The Oklahoma Health Care Authority will implement the DME to Home Health project changes August 1, 2020. The prior authorizations, covered items, limits, and opening/closing coverage to adults will be implemented on August 1, 2020. Pricing changes will be delayed until September 17, 2020.  After pricing changes are implemented, all paid claims with dates of service on or after August 1, 2020 will be reprocessed and adjusted.

7/29/20 Expanded use of telehealth

Provider types/specialties: All

The U.S. Department of Health and Human Services renewed the national public health emergency effective from July 25 through Oct. 23, 2020. OHCA is allowing expanded use of telehealth through Oct. 31, 2020 for most reimbursable services. Read the HHS determination at https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-23June2020.aspx.

7/28/20 Diagnosis Codes on Prescriptions

Dear SoonerCare provider,

The Oklahoma Health Care Authority is capturing diagnosis codes when submitted on a pharmacy claim as per National Council for Prescription Drug Programs billing standards. Pharmacy claims submitted using the NCPDP claim format can enter diagnosis codes in field 424-D0. Pharmacies are encouraged to enter the diagnosis code on a pharmacy claim anytime a diagnosis is written on a prescription. A pharmacist may document the diagnosis code on the original or electronic prescription if confirmed by the patient or the prescriber.

OHCA is encouraging the use of diagnosis codes on prescriptions for contraceptives. The diagnosis code is needed for OHCA federal reporting purposes for contraceptives billed as a pharmacy claim when used as family planning. At this time, the adjudication of the claims will not be affected. However, claims will be denied when a diagnosis is not entered for contraceptive claims in the future. OHCA will alert pharmacies prior to denying claims for contraceptives with no diagnosis. Acceptable diagnosis codes for contraceptives are listed below.

Diagnosis Code   Diagnosis  
Z30* encounter for oral contraceptive management
E28.2 polycystic ovarian syndrome
N80* endometriosis
L70* acne
F32.81 premenstrual dysphoric disorder
N92* excessive, frequent, and irregular menstruation
N93.8 abnormal uterine and vaginal bleeding, specified
N93.9 abnormal uterine and vaginal bleeding, unspecified
*Any number or letter combination of UP TO FOUR numbers and letters of an assigned ICD-10-CM diagnosis code.  
7/27/20 Updated security settings and web browser compatibility

Provider types/specialties: All

OHCA and DXC will be updating their security settings on all of their websites. Please make certain you are utilizing a current browser (IE Version 7 or higher, Chrome 30 or higher, Firefox 24 or higher and Safari 7 or higher with TLS 1.2 ENABLED).

Users utilizing current browser versions should not have any issues accessing the sites. Older versions will need to be upgraded or TLS 1.2 security must be enabled for the secure sites to work appropriately.

Starting 7/31 you may not be able to access these sites if your browser is not TLS 1.2 enabled. We apologize for any inconvenience. If you have questions or need assistance, please call the provider helpline at 800-522-0114.

7/22/20 PASRR LTC 300R Forms

Provider types/specialties: 30, 35

Notice for providers submitting PASRR LTC-300R (Level I) forms:

We have a new option for providers submitting a corrected LTC-300R form.

You may fax the corrected form to 405-530-7111. Please write corrected at the top of the form so staff will know the form is not an original submission.

If you are struggling to submit an LTC-300R form electronically, we are aware of some technical difficulties and are working with the fiscal agent to get those problems fixed. If needed, you may fax the LTC-300R form to the fax number listed above.

When filling out a paper LTC-300R form, be sure to fill in all appropriate fields. The information should be typed or legible. A blank LTC 300R form may be found on the OHCA public website at: http://www.okhca.org/provider/forms/pdflib/binder1.pdf.

Call the OHCA internet helpdesk at 800-522-0114 for technical assistance submitting the LTC-300R form, or if you need help setting up access to the provider portal.

Thanks for serving our members.

7/8/20 SFY2020 Cost Report

Provider types/specialties: 03/30, 31, 34, 35

This is a reminder to LTC providers that all cost reports for the State Fiscal Year ending June 30, 2020, will be due on or before Oct. 31.

You must report costs electronically via the OHCA provider portal, unless you are submitting a partial year cost report. However, if a change of ownership has occurred and you have an entire year of data available, then the two partial reports must be combined and entered on the provider portal.

A new field titled hours has been added to the outside professional LTC cost reporting section of the provider portal. All LTC providers who are required to report outside professional fees, must include total hours when entering an amount in the total cost column.

Thank you for the services you provide to SoonerCare members.

7/6/20 DME to Home Health project changes

Provider types/specialties: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, 52

The Oklahoma Health Care Authority will implement the DME to Home Health project changes Aug. 1, 2020, contingent on CMS approval. There will be four separate webinars set up, two specifically for DME providers and two specifically for case managers. DME provider webinars have been set up and are now on the training page (http://okhca.org/providers.aspx?id=110&parts=7557_7559) and open for registration. Case manager webinars will be set up soon, please continue to watch the training page for these registrations.

7/2/20 Dear Provider Letter 2020-03

Provider types/specialties: 195, 329, 355, 356

Provider letter 2020-03 informs providers about the prior authorization requirements for Lumoxiti, effective Aug. 1, 2020. Please post all comments by close of business Monday, Aug. 3 via the Oklahoma Health Care Authority policy change blog. Thank you.

7/6/20 CARES Act relief fund payments webinar

Provider types/specialties: All

Medicaid and CHIP providers who missed the deadline to apply for CARES Act relief fund payments during the first general distribution will have another opportunity. The U.S. Department of Health & Human Services is planning another opportunity to apply for a provider relief payment equivalent to 2% of total net patient revenue. The timeline has not been released, and HHS is still reserving funds for the payments. HHS will provide guidance when the portal reopens at a future date. Providers who want to learn about the process and relief payments can participate in an HHS webinar at 3 p.m. this Wednesday. Click here to register: https://protect-us.mimecast.com/s/SnerCERBAoH3OXJNuNkZ86?domain=webex.webcasts.com

7/6/20 Telephonic services 99441-99443 and 98966-98968

Provider types/specialties: All

OHCA previously opened coverage for telephonic visit CPT codes 99441-99443 and 98966-98968 to be effective during the COVID-19 public health emergency. As a reminder, per the code descriptions, codes 99441-99443 are billable when telephonic services are rendered by a physician, physician assistant or nurse practitioner, and 98966-98968 are billable when telephonic services are rendered by all other professionals. These services may be utilized in instances when the SoonerCare member does not have access to telehealth equipment, the service is necessary to the health and safety of the member, and the service can safely and effectively be provided over the telephone. During the public health emergency, services can be provided to a new or established patient.

7/1/20 Update To Outside Professional Fee Cost Report Page

Provider types/specialties: 03, 30, 31, 34, 35

A new field titled hours has been added to the Outside Professional LTC Cost Reporting section of the provider portal. All LTC providers who are required to report outside professional fees, must include total hours when entering an amount in the total cost column.

We thank you for your attention to this matter.

6/26/20 Nursing Home rates to cover DME and Supplies

Provider types/specialties: 03, 25

Effective July 1, 2020, nursing home rates will have a one-time adjustment to the base rate. This is to account for long-term care facility providers’ procurement of durable medical equipment, supplies and appliances, including oxygen, from the open market. DME providers who are currently servicing members residing in a nursing facility will need to work with the facilities for reimbursement of equipment and supplies. These changes were previously posted for public notice on the OHCA public notices page, as well as the policy change blog.

6/23/20 Imaging Codes in InterQual

Provider types/specialties: 01, 08, 09, 10, 16, 29, 31, 52

Effective July 1, 2020, OHCA will implement additional imaging codes to run through InterQual guidelines that are embedded into the SoonerCare provider portal PA function. Providers will now need to answer questions in InterQual and submit supporting documents. The use of InterQual guidelines began on Jan. 1, 2018. For details, refer to provider letter 2017-35, 2017-35 and global message dated Oct. 10, 2017 “Upcoming Changes to the Medical Authorization Prior Authorization Process”, 2017 Global Messages

6/23/20 CARES Act relief payments webinar

Provider types/specialties: All

The U.S. Department of Health and Human Services will hold a webinar for Medicaid and CHIP providers on the distribution of CARES Act relief payments. HHS will walk through the process of applying for the provider relief funds. The webinars will be at 1 p.m. Thursday; register here: https://bit.ly/2Z0MBMH.

6/17/20 DME to Home Health project delay

Provider Types: 01, 05, 08, 09, 10, 13, 21, 25, 31, 48, 49, and 52

The Oklahoma Health Care Authority will delay the DME to Home Health project that was to be effective July 1, 2020. DME reimbursement will stay at the current rates. The agency is awaiting CMS review and approval for proposed changes and cannot move forward until the approval process is completed. OHCA continues to evaluate the proposed rates and any additional rate changes will be posted in accordance with the public notification process. The agency anticipates CMS approval by Sept. 30, 2020 and providers will be notified as soon as the new effective date is set.

6/12/20 Provider Relief Fund

On June 9, the U.S. Department of Health and Human Services announced additional distributions from the provider relief fund to eligible Medicaid providers.  

The Oklahoma Health Care Authority would like to encourage all Oklahoma SoonerCare providers to consider applying for these funds, even if they are unsure of their eligibility.  

For additional detailed information, please review the following webpages. 

https://www.hhs.gov/about/news/2020/06/09/hhs-announces-enhanced-provider-portal-relief-fund-payments-for-safety-net-hospitals-medicaid-chip-providers.html

https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html


The application form and the portal used to complete the application can be found here: https://www.hhs.gov/sites/default/files/medicaid-provider-distribution-application-form.pdf

https://cares.linkhealth.com/#/  

6/9/20 Expanded use of telehealth services during the COVID-19 national and state emergency are being extended

Provider types/specialties: All

Telehealth services that have been expanded during the COVID-19 national and state emergency are being extended through September 30th 2020. OHCA will assess the status of the COVID-19 pandemic toward the end of September to determine if the expansion should be extended.

5/29/20 Private Duty Nursing Overtime Rate, COVID-19 related

Provider types/Specialties: 05, 16, 50, 51, 163

Effective March 1, 2020 and for only as long as the national emergency surrounding COVID-19 exists, private duty nursing providers will receive a higher rate of pay for PDN hours that result in over‐time rate of pay for nursing staff. The increase is to be applied only for persons with tracheostomies or who are ventilator dependent.

Providers should bill all PDN hours/units (T1000 CPT billing code), including overtime hours, via the normal electronic claims process. Providers will receive $32.68 per hour ($8.17 per unit) via this regular process.

A secondary payment mechanism is in place for providers to request supplemental payment for an additional $7.32 per hour/$1.83 per unit for OT hours. That process is as follows:

 

Questions may be directed to Carolyn Reconnu-Shoffner, Director, Population Care Management, at 405-522-7630, or Kim Downing, Care Management Supervisor, at 405-522-7145.

5/28/20 2020 Spring Provider Training Workshop

Please join us for the 2020 Spring Provider Training Workshop!

We are excited to offer these virtual webinar-based classes to keep our providers, office managers and their staff up-to-date on current changes and policies. We have classes for all provider types and class descriptions can be found at http://www.okhca.org/Classes. Please join us for these informational sessions starting Tuesday, June 2.

Register now: http://www.okhca.org/Register.

5/22/20 Laboratory Testing for COVID-19 Provider Types: 01, 08, 28

OHCA has recently added coverage for the following additional COVID-19 laboratory testing codes:

87635 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome                     

              Coronavirus 2 (SARS-COV-2) (Coronavirus disease [COVID-19]), amplified probe technique.  

              Effective date March 15, 2020.

86328 – Immunoassay for infectious agent antibody(ies), qualitative or semiqualitative, single step

              method (e.g., reagent strip); severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2)   

              (Coronavirus disease [COVID-19]).                  

              Effective date April 10, 2020.

 

86769 – Antibody; severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus disease

              [COVID-19]). 

              Effective date April 10, 2020.               

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

5/21/20 Claims Submission Update  Provider types/specialties: All

The recent request for all claims to be submitted electronically through EDI or the provider portal has been a great success and we appreciate the provider community for their efforts. With our continued goal of reducing paper use, we will be implementing this as a permanent solution. Therefore, effective June 1, ONLY special process claims that require an appeal or review and have an HCA-17 form attached, will be accepted on paper. All other claims should continue to be submitted in your preferred method of electronic submission.
5/18/20 Long Term Care Pay for Performance Payment Update Provider types/specialties: 03, 30, 35

SFY2020 4th quarter PFP payment will be made on May 20, 2020.

Thank you for your continued service to SoonerCare members.

5/15/20 Expanded use of telehealth services during the COVID-19 national and state emergency are being extended. Provider types/specialties: All

Telehealth services expanded during the COVID-19 national and state emergency are being extended through June 30. OHCA will assess the status of the COVID-19 pandemic toward the end of June to determine if the expansion should be extended.

5/14/20 Telephonic E/M Codes All Provider Types

Effective March 30 and only for as long as the national emergency surrounding COVID-19 exists, telephonic physician E/M codes 99441, 99442 and 99443, and other healthcare professionals E/M codes 98966, 98967 and 98968, can be provided to both new AND established patients.
5/11/20 Psychologist Reimbursement for Adult Crisis Intervention Provider Type: 11/112

Effective immediately and only for as long as the national emergency surrounding COVID-19 exists, independently contracted Psychologists can render and be reimbursed for crisis intervention services provided to adult SoonerCare clients. Providers will bill using HCPCS code H2011, which is reimbursed $20.28 per 15 minute unit.
5/1/20 Update to well-child checks via telehealth Provider Types/Specialties: 08, 09, 10, 13, 316, 318, 322, 344, 345, 349, 359
  • OHCA will not require the pediatric behavioral health screen for each telemed well visit for children ages five and older. The screening requirement is annual unless something with the child has changed.
      
  • OHCA will continue to pay for immunization administration when delivered outside of a well-child visit. The vaccine code must be on the claim.
      
  • OHCA will not require an in-person follow-up well-child visit after a telemed visit. The provider will decide when they need to see the child again.
  • Providers do not need new consent for telemed well-visits if a patient has already signed a consent form to be treated at that clinic. During the COVID-19 emergency declaration, OHCA considers a telemedicine visit to be the same as an in-person visit. The provider and family are allowed to determine if the telemedicine visit is the right service to provide.
  • OHCA’s open telehealth codes will remain open until the emergency declaration has expired. We understand this helps to decrease no-shows and improves access to care in rural locations, so continuation of telehealth after the emergency will be evaluated.
 
4/27/20 Laboratory testing for COVID-19 Provider Types: 01, 08, 28

OHCA is reimbursing laboratory testing for COVID 19 using the following codes established by CMS:
  • U0001 – CDC 2019 Novel Coronavirus (2019-NCOV) real-time RT-PCR Diagnostic Panel (This code to be used for CDC developed tests).
      
  • U0002 – 2019-NCOV Coronavirus, SARS-COV-2/2019-NCOV (COVID-19), any technique, multiple types or subtypes (includes all targets), Non-CDC (This code to be used for non CDC developed tests, i.e. private labs).
      
  • U0003 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.
      
  • U0004 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.
      
As per CMS-2020-01-R, https://www.cms.gov/files/document/cms-2020-01-r.pdf
  • Laboratories are only eligible to bill for U0003 and U0004 if they run COVID-19 testing via high throughput technology that uses a platform that employs automated processing for more than two hundred specimens a day. Examples of high throughput technology as of April 14, 2020 include but are not limited to technologies marketed on that date as the Roche cobas 6800 System, Roche cobas 8800 System, Abbott m2000 System, Hologic Panther Fusion System GeneXpert Infinity System and NeuMoDx 288 Molecular.


OHCA will be monitoring laboratories billing services for U0003 and U004 and may request information on testing equipment and systems as warranted. 

We are unable to reimburse testing billed with new AMA CPT 87635 because CMS has not set pricing guidelines.  If this changes, we will send an update. Providers who have already billed claims for 87635 may rebill their claim using one of the above U-codes. 

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

4/24/20 Message to Providers There was a system modification that resulted in a recoupment of some provider claims related to the administration of VFC vaccines. This recoupment was in error and you will receive the recouped funds on your May 6 remittance advice.

Beginning May 1, the system modification will be in effect. The modification to the system will cause the vaccine administration code to deny if there is no vaccine billed with the administration or the vaccine billed is denied. There is no change in how you bill for vaccines.

If you have additional questions please call the SoonerCare helpline at 800-522-0114
4/21/20 Expanded use of telehealth services during the COVID-19 national and state emergency are being extended

Provider types/specialties: All

Telehealth services that have been expanded during the COVID-19 national and state emergency  are being extended through May 31.  OHCA will assess the status of the COVID-19 pandemic toward the end of May to determine if the expansion should be extended.

4/15/20 Well-child visits via telehealth Provider types/specialties: 08, 09, 10, 13, 316, 318, 322, 344, 345, 349, 359

Effective immediately and only for so long as the national emergency surrounding COVID-19 exists, OHCA will allow well-child visits to be delivered via telehealth for children age 2 and older.OHCA believes telehealth well-child visits for children younger than 2 are not appropriate and would require an in-person visit.Providers will continue to meet the requirements of OAC 317:30-3-27 in delivering telehealth services and must submit claims using the GT modifier.

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.
4/9/20 PT and OT Services via Telehealth

 

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

Effective immediately and only as long as the national emergency surrounding COVID-19 exists, OHCA has expanded the list of PT and OT services allowed to be rendered via telehealth, when appropriate. These services will continue to require prior authorization and include the following CPT codes (please refer to the CPT codebook for code definitions):

• 97110
• 97112
• 97116
• 97161 – 97168
• 97530
• 97533
• 97535
• 97542
• 97755
• 97763

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national and state emergency so all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy, or otherwise indicate why telehealth was utilized, if the service was not reimbursed via telehealth prior to March 16, 2020.

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.
 

 
4/8/20 Home Health Agency and Ambulatory Surgery Centers Contracts Expire April 30, 2020 Home Health Agency and Ambulatory Surgery Center contracts expire April 30, 2020. To avoid any delay in reimbursement, we encourage Home Health Agencies and Ambulatory Surgery Centers to submit their renewals as soon as possible if they have not done so already.

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

4/7/20 Telehealth for Dental Providers Provider Types/Specialties:  08, 27, 270, 271, 272, 273, 274, 275, 276, 277

In accordance with CDC recommendations regarding COVID-19 and the ordinance from Governor Stitt to refrain from any elective dental procedures, OHCA has revised its stance regarding teledentistry. Effective April 1, 2020, SoonerCare will temporarily reimburse providers for use of the D0140 code when coupled with the D9995 code through April 30. An encounter will be considered teledentistry whereby there is a live, two-way, audio-visual, interactive encounter between the patient and the provider. Providers must meet the telehealth requirements in 317:30-3-27. Frequency utilization will be reviewed on a case-by-case basis. If needed, this decision will be revised depending on the future situation. Providers should comply with the ADA policy on teledentistry (link provided below). Teledentistry may be utilized to determine a patient's need for urgent or emergency dental care. All non-essential dental procedures should be postponed.

https://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-teledentistry
4/3/20 Virtual Q & A Sessions

Provider Types/Specialties: All

Oklahoma Health Care Authority is hosting virtual Q&A sessions next week for our SoonerCare providers. We know this is a time of uncertainties and both providers and members are working to understand how COVID-19 may affect them and what SoonerCare is doing to provide support.

These sessions will be held via Zoom and you can find the links for each webinar at https://www.okhca.org/covid19#webinars. Click on the link for your provider type to register, then you will receive a confirmation email containing information about joining the webinar.

3/30/20 Dear Provider Letter 2020-02 PV Types: 01, 08, 09, 10, 31, 52

Provider letter 2019-24 informs providers about the prior authorization requirements for Soliris, effective May 1, 2020. Please post all comments by close of business Friday, May 1, 2020, via the Oklahoma Health Care Authority policy change blog. Thank you.
3/27/20 Telehealth for Dental Providers Provider Types/Specialties: 08, 27, 086, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279

OHCA has reviewed the possibility of opening codes for teledentistry and has concluded that current CDT dental codes do not allow for virtual encounters in the absence of real time diagnostic procedures. Many of you will continue to see patients for emergency care during this time. You will continue to receive reimbursement for procedural codes performed for patients seen in real time.

3/25/20 PT and OT services via telehealth Provider Types/Specialties: 08, 17, 087, 170, 171, 174, 175

Effective immediately and only as long as the national emergency surrounding COVID- 19 exists, OHCA will allow certain PT and OT services to be rendered via telehealth when appropriate. These services include the following CPT codes: 97110 (therapeutic exercise), 97530 (therapeutic activities), and 97535 (home management training for ADLs). These will need to be submitted with the GT modifier. These services will continue to require prior authorization. PT and OT evaluation and re-evaluation services are not appropriate for telehealth and will not be allowed.

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national and state emergency so all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020.

If you have any questions, please call the OHCA provider helpline at 800-522-0114. Thank you for your support of SoonerCare.

3/23/20 PASRR Face-to-face assessments Provider Specialties/Types: 01, 03, 04, 63, 013, 030, 031, 034

Due to the outbreak of COVID-19 and Governor Stitt’s Executive Order 2020-06, PASRR face-to-face assessments will be suspended for an indefinite time period. PASRR assessments may be completed by the following methods: telehealth or video conferencing if available, phone conference, desk review of all medical and mental health information, consults with hospital and nursing facility staff, phone consults with guardian or power of attorney and phone consults with significant others, if authorized by the Individual. 
3/20/20 Behavioral Health Providers Effective immediately and only for so long as the national emergency surrounding COVID-19 exists, services rendered by behavioral health providers via telephone will use the HCPCS/CPT codes listed in the rates & codes sheets applicable to their provider type found at www.okhca.org/behavioral-health using the GT modifier. Services should only be delivered telephonically (non face-to-face) in instances when the SoonerCare member does not have access to telehealth equipment, the service is necessary to the health and safety of the member, and the service can safely and effectively be provided over the telephone.

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national/state emergency so that all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020

3/19/20 Claims Submission Provider Types/Specialties: All

Effective immediately all providers must submit their claims electronically through EDI or the Provider Portal starting today. All efforts will be made to process paper claims previously received, but there is likely to be long delays in the process. When submitting attachments for claims, all attachments should be uploaded and not faxed. If you need assistance or training on submission of claims or uploading attachments via the Provider Portal, please contact the Education team or Field staff at soonercareeducation@okhca.org or call Provider Services at 800-522-0114.
  
3/17/20 Expanded use of telehealth and telephonic services during COVID-19 National/State Emergency for COVID-19 The Oklahoma Health Care Authority is allowing expanded use of telehealth beginning March 16, 2020 through April 30, 2020 for services that can be safely provided via secure telehealth communication devices for all SoonerCare members. OHCA will assess the status of the COVID-19 situation toward the end of April to determine if the expansion should be continued. Providers will continue to meet the requirements of OAC 317:30-3-27 in delivering telehealth services and must submit claims using the GT modifier. Additionally, the use of telephonic services (non face-to-face) may be utilized in instances when the SoonerCare member does not have access to telehealth equipment, the service is necessary to the health and safety of the member, and the service can safely and effectively be provided over the telephone. For providers who bill E&M codes, the codes for telephonic services are 99441, 99442 and 99443. Other healthcare professionals can bill using 98966, 98967 and 98968.

Providers are encouraged to create internal policies and procedures regarding the use of telehealth during a national/state emergency so that all staff understand its appropriate use during this time. Documentation in the client’s record should either reference the provider’s internal policy or otherwise indicate why telehealth was utilized if the service was not reimbursed via telehealth prior to March 16, 2020.

If you have any questions, please call the OHCA Provider Helpline at 800-522-0114. Thank you for your support of SoonerCare.

3/12/20 Prior Authorization Requests Effective April 1, 2020, when submitting prior authorization requests on the provider portal using the Medical radio button, you will be required to upload the supporting documentation at the time of submission. If you select the “submit” button prior to uploading supporting documentation, you will receive the following error message, “One or more attachments is required for this PA.”
3/10/20 Dental procedure code D4346 Provider types/specialties: 270, 271, 272, 273, 274, 275, 276, 277, 080

Effective March 1, 2020, providers may request a prior authorization for utilization of the D4346 code - scaling in the presence of generalized moderate or severe gingival inflammation. This code may be utilized for the removal of plaque and heavy calculus in the presence of swollen or inflamed gingiva, generalized suprabony pockets and moderate to severe bleeding on probing. It is indicated for patients with heavy calculus and deep probing pocket depths, in the absence of periodontitis (bone loss). When submitting for preauthorization, please include photographs along with radiographs and periodontal charting. Please consult the ADA CDT Dental Procedure Codes manual for more information on this code.

3/6/20 Request for Claims Resubmission Due to system issues caused by a server upgrade, all providers who uploaded a claim or prior authorization attachment on March 5, need to resubmit these documents. We apologize for any inconvenience.
2/12/20 Maternal Depression Screening at Well-Child (EPSDT) Visits Provider types/specialties: 085, 088, 090, 093, 100, 130, 132, 316, 318, 345, 349

The American Academy of Pediatrics (AAP) recommends integrating postpartum depression screening and assessment at the one, two, four, and six month well-child (Early and Periodic Screening, Diagnostic and Treatment) visits. SoonerCare providers are encouraged to administer this important screening at these recommended visits. SoonerCare allows reimbursement of maternal depression screening when provided in accordance with the AAP Bright Futures periodicity recommendations. CPT code 96161 is currently reimbursed at $5.00. AAP recommendations for surveillance, screening tools, follow-up and more can be accessed at https://pediatrics.aappublications.org/content/143/1/e20183259

2/6/2020 SoonerCare Pharmacy Program Updates OHCA will be presenting a webinar titled SoonerCare Pharmacy Program Updates on Tuesday, Feb. 25 at 2:30 p.m. The target audience will be providers, prescribers and pharmacy personnel.

This class will supply providers with a high level overview of the OHCA pharmacy program. The presentation will have an emphasis on prescription drug abuse in the state, morphine milligram equivalent and medication assisted treatment changes. In addition, the prior authorization process, drug rebate program and other pharmacy initiatives will be discussed.

Register here to attend the SoonerCare Updates & Changes webinar: https://okhca.zoom.us/webinar/register/WN_OyMWmLrIR-abFcsf17IX3A  

After registering, you will receive a confirmation email containing information about joining the webinar.

1/22/2020 Physician Assistants Contracts Expire 01/31/2020 Physician assistants contracts expire Jan. 31, 2020. To avoid any delay in reimbursement, we encourage physician assistants to submit their renewals as soon as possible if they have not done so already.

If you have any questions, please contact provider enrollment at 800-522-0114, option 5, or email ProviderEnrollment@okhca.org.
1/9/2020 SoonerCare Updates & Changes OHCA will be presenting a webinar titled "SoonerCare Updates & Changes" on Thursday, January 30th at 2:30 PM. This webinar is for all SoonerCare and Insure Oklahoma providers.
 
The webinar will cover the many updates and changes within the SoonerCare program. Some topics will include the "Oklahoma Residency Verification Process" policy, Telehealth services, maternal depression screenings, Vaccines for Children and other subjects.

Register here to attend the "SoonerCare Updates & Changes" webinar: https://okhca.zoom.us/webinar/register/WN_ezDupW8DTsO4BlB0_GBAow
 
After registering, you will receive a confirmation email containing information about joining the webinar.
1/2/2020 Spravato (esketamine nasal spray) administration Effective Jan. 1, 2020, OHCA will cover HCPCS code G2082 and G2083 for Spravato (esketamine nasal spray) administration. These codes describe the supply of the medication, administration and observation time. These services will require a prior authorization through the pharmacy prior authorization unit.   

When a provider is monitoring the administration of the medication but does not supply the drug, they should bill separately for the appropriate evaluation and management service as well as for the observation time using CPT codes 99415 and 99416. 99415 and 99416 will also require a prior authorization through the pharmacy prior authorization unit.  

As a note, 99415 and 99416 will only be covered for the observation time associated with Spravato (esketamine nasal spray) administration at this time. As other similar drugs become available that also require extended observation, this will be reviewed.