OHCA Policies and Rules

Search Entire Policy
OHCA Policies and Rules Main Page

317:25-7-29.Screening, diagnosis and preventive benefits
[Revised 01-01-09]

(a) The PCP is responsible for coordinating or delivering preventive and primary care services which are medically necessary to all SoonerCare members enrolled with him/her.

(b) School and health department clinics may conduct EPSDT screening examinations on children who have not been screened by their PCP pursuant to the EPSDT periodicity schedule. If it is ascertained that a child is not current, the school or health department clinic must first contact the PCP and attempt to set up an appointment for the child within three weeks.  If the PCP cannot meet this condition, the clinic will be permitted to conduct the screen and bill fee-for-service.

(1) The school or health department clinic must submit a claim for reimbursement, as well as documentation that:

(A) the PCP was contacted and an examination could not be conducted by the PCP within the specified guidelines; and

(B) the PCP has forwarded information for the patient file regarding the diagnosis, services rendered and need for follow-up. This documentation must be returned to the child's record for verification that PCPs have first been contacted and that school and health department clinics are providing PCPs with the information necessary to ensure continuity of care.

(2) The school-based clinic or health department must conduct the screening examination within three weeks from the date the determination was made that the PCP could not conduct the exam within the specified guidelines.



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.