2008 Global Messages

Posted
Date

Subject

Message

12/1/2008 Revised Relative Value Base Units

Title: Revised Relative Value Base Units

PV Types: All

Run Dates: 12/01/2008 – 01/15/2009

Message:

Effective 01/01/2009 CMS has revised the relative value base units which will impact overall SoonerCare reimbursement on certain procedure codes.

Go to www.cms.hhs.gov/center/anesth.asp for more information.

11/25/2008 CNAs graduated from OSU-OKC Training Program

Title: CNAs graduated from OSU-OKC Training Program

Run Dates: 11/25/2008 – 01/15/2009

PV: 030 – Nursing Facility, 031 – ICFMR > 6 beds, 034 – ICFMR < 6 beds, 035 – Skilled Nursing Facility

Message:

Upon the hiring of a CNA graduate of OSU-OKC, please note the following:

1. The CNA graduate is obligated by the OHCA program to obtain employment with a contracted SoonerCare facility;

2. On the first day of employment, the CNA is to obtain a completed verification form. Completion of the employment verification form consists of getting a signature from the Human Resources staff at the SoonerCare Contracted Nursing Facility. To obtain a copy of this form, you may visit the OSU-OKC website at www.osuokc.edu/cna. For more information you may contact OSU-OKC staff Melissa Ford or Jennifer Fessler at (405)945-8615, or OHCA Project Coordinator LaQueda Viewins at LaQueda.Viewins@okhca.org or at (405)522-7538.

You will receive a detailed letter in the mail soon concerning this requirement and process.

10/13/2008 Choice Contract Renewals & Documents

Title: Choice Contract Renewals & Documents

Run Dates: 10/13/2008 – 12/15/2008

PVs: 31- Physicians

Message:

Choice Contract Renewals and Documents are now accessible on the OHCA website: www.okhca.org.

The Contracts, Amendments and Assessment Forms are located under Provider Enrollment. Assessment Forms are also located on the Medical Home portion of the website.

If you have any questions, please contact Provider Services at 1-877-823-4529, option #2.

IMPORTANT DATE: Your contract renewals must be submitted to OHCA no later than November 21, 2008.

10/9/2008 Incentive Components of Medical Home

Title: Incentive Components of Medical Home

To: 31 – Physicians

Run Date: 2008/10/09 – 2008/11/24

Message:

Incentive payments will be made quarterly.  The first payment made in April 2009 will be based on claim dates of service Oct-Dec 2008.  These claims must be submitted and go to a paid status before March 31, 2009.  If you have questions on how to get your denied encounter claims to a paid status please contact the OHCA Call Center @ 1-800-522-0114 option 1. 

10/9/2008 2008 Fall Provider Workshops

Title: 2008 Fall Provider Workshops

To: All Providers

Run Dates: 10/09/2008 – 11/07/2008

All Providers:

Fall Provider Workshops begin Thursday, October 9, 2008 in Lawton. Registration for Lawton and Tulsa is now closed. Only walk-in registrations will be allowed at these two locations on the day of the training.

Pre-registration for Durant and OKC is still open at this time. We are offering many new classes that will benefit all providers and encourage everyone to attend.

Class information and registration forms for the remaining locations can be found on the OHCA website at: http://www.okhca.org/providers.aspx?id=110 

Please send in your registration today, to reserve your spot! We look forward to seeing you there!

9/22/2008 Claims Process – Outpatient Services

Title: Claims Process – Outpatient Services

Run Dates:  09/22/08 – 11/03/08

PV Types:  01 - Hospitals 02 - ASC Facilities

Message:

OHCA is currently in the process of modifying our claims process for outpatient services. If a second claim for the same member/same date of service is received, the second claim will deny. This modification to the system should be completed in September. We will let you know the effective date of this new claims process.

Recoupment will be made of inappropriate payments generated by the current claims process.

9/15/2008 2008 Fall Training

Title: 2008 Fall Training

PV Types: All

Run Dates: 09/15/2008 – 11/07/2008

Message:

OHCA and EDS, a Hewlett Packard company, will be conducting the Fall 2008 SoonerCare Provider Training Workshops which will include several specialty sessions for specific provider types. If you would like to attend, please complete the registration form that can be accessed on the OHCA Public Website, www.okhca.org, under the provider training link. We look forward to seeing you there!

9/15/2008 MAU PA Workflow System

Title: MAU PA Workflow System

PV Types: 01-10, 12-23, 25, 26, 28-31, 36-41, 43-44, 47-53, 57

Run Dates: 09/15/2008 – 11/01/2008

Message:

The OHCA Medical Authorization Unit implemented a new prior authorization (PA) workflow system on April 7, 2008, to allow a more efficient work flow to the prior authorization process. A new fax number and mailing address were required to implement this new system.

Effective April 7, 2008, all prior authorization requests must be submitted to fax number 702-9080 (local) or 1-866-574-4991 (toll free). The new mailing address is EDS, Prior Authorizations, 2401 NW 23rd, Suite 11, OKC, 73107.

The old fax number and mailing address are no longer available. Any PA request submitted to the old fax number or old mailing address will not be processed.

9/3/2008 HCA-28 Form

Title: HCA-28 Form

Run Date: 09/04/2008 – 10/20/2008

Pv Types: All

Message:

Please remember that ONLY Medicare Crossovers, Medicare Supplements and Medicare Replacements require providers to complete the HCA-28 form. This form should not be used for any other claim types. If you currently are using the HCA-28 for HMO co-pays or Third Party Liability Claims, please discontinue the use of this form immediately. The use of this form for any other claims, other than Medicare could cause your claim to deny or be processed incorrectly.

9/3/2008 Hurricane Gustav Evacuees

Title: Hurricane Gustav Evacuees

Run Dates: 09/04/2008 – 10/20/2008

Pv Types: All

Message:

In response to evacuations due to Hurricane Gustav, OHCA has been in contact with the Louisiana and Mississippi State Medicaid agencies concerning evacuees with Medicaid coverage who may need medical services here in Oklahoma.  Both Louisiana and Mississippi have requested that medical providers submit claims directly to the appropriate state Medicaid agency. 

For providers who wish to enroll in Louisiana Medicaid and were not enrolled as a Hurricane Katrina providers, they should go to the Louisiana website www.dhh.louisiana.gov/offices/?ID=92 and  click on  Gustav in black circle. Scroll down to Medicaid providers for instructions for enrolling   Providers who were enrolled for Katrina can email their Katrina provider number and NPI to jphilli2@dhh.la.gov. and their number will be reactivated.

For providers who wish to contract with Mississippi Medicaid you may find contracting information on their web site at www.Medicaid.state.ms.us.

If you have further questions please contact OHCA Provider Services at 1-877-823-4529, option 2.

8/18/2008 Modifier Changes

Title: Modifier Changes

Run dates: 08/18/2008 – 10/05/2008

PV Types: All

Message:

Beginning with dates of services of 09-01-2008 and later, the following modifiers will become processing modifiers and reduce reimbursement by 50% of the allowable rate which follows CPT and HCPCS national guidelines. 

53 - DISCONTINUED PROCEDURE   

73 - DISCONTINUED OUTPATIENT PROCEDURE PRIOR TO ANESTHESIA ADMINISTRATION

GM - MULTIPLE TRANSPORTS

8/18/2008 Therapy Modifiers

Title: Therapy Modifiers

Run Date: 08/18/2008 – 10/01/2008

PV Types: 17; 170; 171; 173;174,175

Effective October 1, 2008, the following modifiers must be included in all therapy prior authorization requests (physical, occupational and speech):

1. Physical Therapy—GP
2. Occupational Therapy—GO
3. Speech Therapy—GN

All prior authorization requests for therapy services received after October 1, 2008, without the appropriate modifier will be returned to the provider for amendment.

8/18/2008 Electronic Newborn Eligibility Process  (NB-1)

Title: Electronic Newborn Eligibility Process  (NB-1)

Run Dates: 08/18/2008 – 10/05/2008

PV Types: 01

Message:

NB-1 is a new on-line enrollment process available to hospitals which will allow enrollment of a SoonerCare newborn. Upon completion of the enrollment, the facility will receive real-time approval and a SoonerCare ID number for the newborn. If you would like for your facility to have access and training for the NB-1 application, please contact the Internet Help Desk at 1-800-522-0114, Option 2.1, Monday through Friday from 8am-12noon and 1pm-5pm. Access to our secure website is necessary in order to begin the on-line process.

8/1/2008 Reminders:  Modifiers 25 & 59


Title: Reminders:  Modifiers 25 & 59

Run Dates: 08/01/2008 – 09/15/2008

PVs: 89, 09, 10, 31, 52

Spc: 082, 090, 091, 093

Message:

Effective October 1, 2005, claims billed with modifier 25 will be denied unless sufficient documentation is attached to the claim. Claims utilizing modifier 25 must include documentation (office notes) to justify payment for a significant and separately identifiable evaluation service by the same physician on the same day of a minor (global) surgery/procedure.

Effective January 15, 2007, claims with modifier 59 will be reviewed. These claims must have sufficient documentation (Op reports when applicable) to justify payment for a distinct and separate procedural service. Claims submitted without sufficient documentation will be denied.

7/28/2008 Procedure Code 90887

Title: Procedure Code 90887

Run Dates: 07/28/2008 – 09/13/2008

Pv Types: All

Message

Effective 08/01/2008, the OHCA will provide program coverage for TXIX and Custody, on procedure code 90887: Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patients, when medically necessary. The code is used primarily by behavioral pediatricians to give detailed explanations of neuropsychiatric test results. Coverage is limited to once per calendar year.

7/25/2008 Xover claims with inadequate denials

Title: Xover claims with inadequate denials

Run: 07/25/2008 – 09/01/2008

PVs: All

Message:

If you have experienced problems with your x-over claims not giving adequate denials, you can begin resubmitting these claims at this time. They will need to be resubmitted on a paper claim with the HCA-28 attached.

06/26/2008 thru 08/05/2008 Soon-to-be-Sooners (STBS) Claims

Title: Soon-to-be-Sooners (STBS) Claims

Run Dates: 06/26/2008 thru 08/05/2008

PV Types: All

Message:

OHCA is attempting to expedite the review process for all alien and STBS claims. In order to assist in this process, there are a few simple suggestions that will help you get your claim successfully paid the first time. 

For claims in which the member has the alien benefit package only, every claim should include enough documentation to establish the emergent nature of the care. 

For claims in which the member has both the alien/STBS benefit package, the only claims that will not require documentation are routine OB care or actual delivery services. 

For all other claims, it is advisable to include documentation regarding the necessity or emergent nature of the services provided.

If you have recently received a denial of an alien claim, it is more than likely attributed to the lack of documentation.

6/16/2008 NDC Billing for Drugs with HCPCS Code

Title: NDC Billing for Drugs with HCPCS Code

To: All Providers

Run: June 16, 2008 – August 1, 2008

Message:

When billing multiple NDC numbers per J code (Q code, S code, or CPT 90378), use the billing modifiers of KP (first drug of a multiple drug of a unit dose formulation) and/or KQ (second or subsequent drug of a multiple drug unit dose formulation). The J code units must match the quantity administered for each NDC billed. Up to three NDC numbers may be reported per J code. Continue to check the OHCA website for updates.

6/10/2008 Reminder: Fee Schedule – Annual Update

Title: Reminder: Fee Schedule – Annual Update

Run Dates: June 10 – July 25, 2008

PVs: All

Message:

Remember, the Oklahoma Health Care Authority updates the provider Resource Based Relative Value System (RBRVS) fee schedule every July. This corresponds with our state fiscal year.

The other advantage in waiting until July is that the Centers for Medicare & Medicaid Services (CMS) have made all the adjustments to the Relative Value Units (RVUs), and we do not have to update our file more than once.

6/5/2008 Updated Pricing

Title: Updated Pricing

Run Dates: 06/05/2008 – 07/20/2008

PV Types: DME: 25 / SPC: 250

Message:

The Oklahoma Health Care Authority has updated its pricing on the following CPT and/or HCPCS code(s) effective July 1, 2008:

  • Code:  A4406
  • Updated Price: 2.22 per ounce (each unit)

Reason(s) for Update: 

  1. Error in existing price
  2. Industry Standard

Thank you for your continued service to SoonerCare members.

6/4/2008 Paper Claims/Legacy ID Numbers

Title: Paper Claims/Legacy ID Numbers

PV: All

Run Dates: 06/04/2008 – 07/20/2008

Revised Message:

ATTENTION PAPER CLAIM FILERS:  We are receiving a large quantity of paper claims with no SoonerCare Provider ID number, also known as Legacy Numbers. PAPER CLAIMS REQUIRE A SOONERCARE PROVIDER ID NUMBER AND CAN NOT BE PROCESSED WITH NPI ONLY.

You MUST include your SoonerCare Provider ID Number on paper claims:

Paper 1500’s – Block 33b or 24j
Paper Xover 1500’s – Block 33b
Paper UB04 – Block 57

All paper claims that do not include a SoonerCare Provider ID Number will be returned to you and not entered into the system for processing.

5/23/2008 NPI Update

Title: NPI Update

Run Date: 05/22/2008 – 07/05/2008

PV Types: 01 thru 23; 24; 26 thru 30; 31, 48, 52, 53,

Specialties: 010 - 016; 020; 031 - 037; 040, 060, 071, 072, 073, 080 - 095; 100; 101; 110 - 121; 130, 140, 150, 160 - 163; 170 - 175; 180 - 185; 190, 200; 210, 211, 213 - 228; 230, 240, 260 - 267; 270 - 277; 280, 281, 290, 291, 292, 300, 310, 311 - 347;  480, 530, 531 - 535

Message:

NPI (National Provider ID) is now live in Oklahoma. We are receiving many calls regarding some of the details for direct data entry on the Internet. Please follow these instructions for the most accurate and timely results:

When sending attachments for electronic claims or prior authorizations, please make sure the attachment cover sheets, HCA-13 or HCA-13A, have your legacy ID number only in the provider ID field. Do not use your NPI on the HCA-13. These forms do not require an NPI.

Use a contract code (CN1) ONLY if your recent Letter 2008-18, and follow up 2008-31, contained a contract code.

Only non-medical providers (providers not required to obtain NPI) should enter a legacy number in the SC rendering fields.

If your billing and rendering provider ID are the same number, you must double click in the Rendering field and the system will auto-populate the field.

Thank you for your patience during this new implementation. And as always, thank you for your service to SoonerCare members.

5/20/2008 NPI Continued

Title: NPI Continued

Run Dates: 05/20/2008 – 07/01/2008

PV Types:  01 thru 23; 24; 26 thru 30;  31, 48, 52, 53,

Specialties: 010 - 016; 020; 031 - 037; 040, 060, 071, 072, 073, 080 - 095; 100; 101; 110 - 121; 130, 140, 150, 160 - 163; 170 - 175; 180 - 185; 190, 200; 210, 211, 213 - 228; 230, 240, 260 - 267; 270 - 277; 280, 281, 290, 291, 292, 300, 310, 311 - 347;  480, 530, 531 - 535

Message:

For further info please refer to the Global and/or Banner messages dated May 19, 2008 titled Implementation of Federal Mandate for NPI.

After NPI, you will continue to have a Sooner Care provider ID for use in some situations, but you will have a single ID for the Traditional (fee-for-service), Choice, and Insure Oklahoma/O-EPIC programs. If you are both a Choice and O-EPIC PCP, the single ID will be your Choice number. If you are a PCP for O-EPIC only, your O-EPIC ID will be your single number.

On the Internet secure site, only the PIN for your new single ID will remain active. If you have questions about which provider ID will be your single ID, please call Provider Enrollment at 1-800-522-0114 option 5.

5/19/2008 Implementation of Federal Mandate for NPI

Title: Implementation of Federal Mandate for NPI

Run Dates: 05/19/2008 – 07/01/2008

PV Types: 01 thru 23; 24; 26 thru 30; 31, 48, 52, 53,

Specialties: 010 - 016; 020; 031 - 037; 040, 060, 071, 072, 073, 080 - 095; 100; 101; 110 - 121; 130, 140, 150, 160 - 163; 170 - 175; 180 - 185; 190, 200; 210, 211, 213 - 228; 230, 240, 260 - 267; 270 - 277; 280, 281, 290, 291, 292, 300, 310, 311 - 347; 480, 530, 531 – 535


Message:

Implementation of the Federal Mandate for NPI will begin Thursday, May 22, 2008. If you do not have an NPI on file, please fax your NPI and the provider ID that is associated with the NPI to 405-530-3224 immediately! Please refer to the OHCA Dear Provider Letter 2008-18, dated March 21, 2008 re: billing instructions, “clarification of how to submit professional claims with your NPI”.


Your web-submitted claims WILL DENY beginning May 22, 2008 if your NPI information is not on file. Please note that NPI does not apply to paper claim submission.
If you have any questions about billing, please call 1-800-522-0114 option 2-1 for internet assistance or option 2-2 for Electronic Data Interchange (EDI) assistance.


Thank you.

5/6/2008 Reminder: Spring 2008 Training Workshops

Title: Reminder: Spring 2008 Training Workshops

To: All Providers

Run: 05/06/08 -  05/25/08

Subject: Reminder: Spring 2008 Training Workshops

Message:

Please join us for the Spring 2008 Provider Training Workshops in either Tulsa on May 20-21, 2008, or in Lawton on May 28-29, 2008.

Seating for both locations is still available but is limited and on a first-come basis. Tulsa registration will close on May 13th.  Lawton registration will close on May 21st.

A copy of the invitation and course descriptions is available on the OHCA website at: www.okhca.org.  From the website go to: Provider, Provider training, Spring Provider Training Registration Form and Course Description.

We look forward to seeing you there.

5/5/2008 Soon-to-be-Sooners

Title: Soon-to-be-Sooners

Run: 05/02/2008 – 06/16/2008

Providers: All

Message:

You are welcome to call to discuss any questions about the new Soon-to-be-Sooner program with our Child Health department. We are reviewing and updating this new program, which began 04-01-08.  As always, you will be notified in writing as changes to this program are made. Thank you for your continued participation in the SoonerCare Program.

5/1/2008 Rate Review Committee Survey

Title: Rate Review Committee Survey

Run: 05/05/2008 – 06/16/2008

Pv types: All

Message:

Oklahoma House Bill 1926 established an ADvantage Waiver and Home and Community Based Waiver Rate Review Committee to review the reimbursement rates received for these services and make recommendations to the Legislature regarding the rates. 

Have you completed your cost data survey? The deadline for submission is May 16, 2008.

4/25/2008 PT/OT Video

Title: PT/OT Video

Run: 04/25/2008 – 06/10/2008

PVs: 170, 175, 336, 171, 174

Message:

A training video for Physical and Occupational Therapists is now accessible from the OHCA Web site under the WHAT’S NEW caption. We hope it will be beneficial to you. Or you can visit http://www.okhca.org/provider-training.

4/25/2008 Mediflight

Title: Mediflight

Run Date: 04/25/2008 – 06/10/2008

PVs: 26, 260, 261

Message:

If a member’s medical condition requires support and monitoring by a licensed medical professional during transport, the documentation must clearly support the medical necessity for the increased level of support, including identifying the person providing the increased level of medical support and their designation. The medical review team can not approve claims if this documentation is not provided.

4/25/2008 PA Requests

Title: PA Requests

Run date: 04/25/2008 – 06/10/2008

PVs: All

Message:

Prior Authorization requests and additional documentation for DME and PT/OT/ST for the OHCA MAU unit cannot be processed without the new HCA-13A coversheet and will be returned to the originating fax number or address for correction.  Please use the HCA-13A as your only coversheet as it slows down the process to send unnecessary attachments.

Also, for new PA requests, please fill out ALL required fields on the HCA-12A. They will not be processed with missing information.  Required fields are:

Provider Number – Section IV OR I
Recipient Number – Section II
Date Span - Section V
Procedure Code – Section VI
Modifiers – Section VI, if applicable
Units – Section VI

If one or more of these items are missing from the HCA-12A, it will be returned to the originating fax number or address for correction. Once corrections have been made, please return all original corrected documents to the published PA request fax number below.

DME and PT/OT/ST PA requests (including requests for extra diabetic supplies) should be faxed to: OKC Metro: (405) 702-9080, or Toll-Free: (866) 574-4991; or mailed to Prior Authorizations, EDS, 2401 NW 23rd, Suite 11, Oklahoma City, OK 73107.

NOTE: Please remember the Process for Pharmacy, Dental, Behavioral Health and all other PA requests has not changed. Please review the Provider Billing and Procedure Manual for specific instructions for your provider type.

4/25/2008 Correct NPI

Title: Correct NPI

Run Date: 04/25/2008 – 06/10/2008

TO: PV

Types: 01 thru 23; 24; 26 thru 30;  31, 48, 52, 53,

Specialties:   010 - 016; 020; 031 - 037; 040, 060, 071, 072, 073, 080 - 095;
   100; 101; 110 - 121; 130, 140, 150, 160 - 163; 170 - 175;
   180 - 185; 190, 200; 210, 211, 213 - 228; 230, 240, 260 - 267;
   270 - 277; 280, 281, 290, 291, 292, 300, 310, 311 - 347;  480,
   530, 531 - 535

Message:

Use the NPI that is associated with your contract when billing for professional services. DO NOT bill with your group NPI, even if you are part of a group practice, unless you have a group contract on file with OHCA. You need to bill with your individual NPI for the claims to process.

4/23/2008 Insure Oklahoma/O-EPIC

Title: Insure Oklahoma/O-EPIC

Run: April 23 – June 10, 2008

Pvs: All

Message:

Insure Oklahoma/O-EPIC is a state program initiated to assist in helping insure working Oklahomans.  The Insure Oklahoma/O-EPIC Individual Plan (IP) uses the same provider network as SoonerCare.

Specialists that are contracted to accept SoonerCare members can also accept Insure Oklahoma/O-EPIC IP subscribers without any additional contracting.

Eligibility for Insure Oklahoma/O-EPIC IP can be verified the same way you check eligibility for SoonerCare, you are looking for PUB instead of TXIX.

Claims for Insure Oklahoma/O-EPIC IP are billed the same as SoonerCare claims.  Insure Oklahoma/O-EPIC IP subscribers are assigned to a primary care physician, will need a referral for services rendered outside the primary care physicians office.

Some benefits are limited (example: dental & ambulance are not covered by Insure Oklahoma/O-EPIC IP). Please check your procedure code for coverage under the PUB program.

Reimbursement rates for Insure Oklahoma/O-EPIC are similar, however, for covered codes, the provider may collect the patient co-payment at the time of service and payment is based upon SoonerCare Fee for Service rates.  The co-payments are listed on the patient card or you may call the Helpline at 888-365-3742. 

Thank you for your service to SoonerCare & Insure Oklahoma/O-EPIC patients.

4/23/2008 Medical Justification for Glasses

Title: Medical Justification for Glasses

Pv: 18 - Optometrist, 180 - Optometrist (spc), 330 - Ophthalmologist

Run: April 23 – June 7, 2008

Message:

In the last edition of our Provider Newsletter there was an article related to Prior Authorization requests for glasses. Prior Authorization is not required. However, medical justification for glasses must be clearly documented in your office chart for post payment reviews. Care Management staff is available: 1-877-823-4529, option 5; if you feel we need to discuss frequent replacement concerns with the parents.

4/7/2008 30-Day Retro Authorizations

Title: 30-Day Retro Authorizations

TO: DME Providers: 25; 250

Run: April 7 – May 22, 2008

Message:

In review of provider letter 2008-15 and 2008-20 it has come to our attention that the 30-day retro review needs further clarification prior to implementation. Please disregard that portion of the letter. We will keep you notified as we proceed towards implementation.

Reminder: All PA requests must be submitted with the HCA-13A coversheet.

New Fax Numbers for PA requests effective April 7, 2008:  Local - 405-702-9080;
Statewide Toll Free - 1-866-574-4991.
For questions, please call 1-800-522-0114, option 6, then option 4.

4/7/2008 NDC Billing for Drugs with HCPCS Code

Title: NDC Billing for Drugs with HCPCS Code

To: Pharmacies:  24, 240

Run: April 7 – May 22, 2008

Message:

When billing multiple NDC numbers per J code (Q code, S code, or CPT 90378), use the billing modifiers of KP (first drug of a multiple drug of a unit dose formulation) and/or KQ (second or subsequent drug of a multiple drug unit dose formulation). The J code units must match the quantity administered for each NDC billed. Up to three NDC numbers may be reported per J code. Continue to check the OHCA website for updates.

3/27/2008

Corrected FAX Numbers for PA Requests

Title: Corrected FAX Numbers for PA Requests

Run: 03/27/2008 – 05/15/2008

PV Type: 025 – DME, 170 – PT, 171 – OT, 173 – Speech Therapy

Message: Corrected Fax Numbers for Prior Authorization Requests

The new fax numbers for prior authorization requests listed in the 03-17-08 Changes to the PA Process global message and in the Provider Letter OHCA 2008-15 (announcing the OHCA Medical Authorization Unit’s new workflow system for prior authorization), dated 03-20-08, are incorrect. The new fax numbers for prior authorization requests (effective 04-07-08) are: 405-702-9080 (local) and 1-866-574-4991 (statewide toll-free). The current fax number will be disconnected effective 04-07-08. For questions regarding this new change, please call our toll-free number: 800-522-0114.

3/17/2008

Changes to the PA Process

Title: Changes to the PA Process

Run Dates: 03/17/2008 – 05/05/2008

PV Types: 025 – DME, 170 – PT, 171 – OT, 173 – Speech Therapy

Message:

The OHCA Medical Authorization Unit will implement a new prior authorization (PA) workflow system on April 7, 2008. We anticipate the new system will allow a more efficient work flow, expediting the prior authorization process for our members and providers. The new system will continue to require an HCA-13A cover sheet with every PA submission. A change in the fax number and mailing address was required to implement the new system. Effective April 7, 2008 prior authorization requests must be submitted to fax number 702-9080 (locally) or 1-866-524-4991 (statewide toll free). The new mailing address is EDS, Prior Authorizations, 2401 NW 23rd, Suite 11, Oklahoma City, OK 73107. The current fax number and mailing address will no longer be available after midnight April 6, 2008.

Also beginning April 7, 2008 prior authorization requests must be received within 30 days of the initial date of service. Any service provided more than 30 days before the prior authorization request was submitted will not be authorized.

3/17/2008 Tamper Resistant Prescription Pads

Title: Tamper Resistant Prescription Pads

Run: 03/15/2008 – 05/01/2008

Pvs: All

Message:

Federal requirements for tamper-resistant prescription pads take effect soon. On April 1, written prescriptions for SoonerCare members must have at least one of these characteristics: 1) A feature to prevent unauthorized copying, 2) A feature to prevent erasure or modification, 3) A feature to prevent use of counterfeit prescription forms. All three characteristics will be required effective October 1.    

For more information, see www.okhca.org. Please reference Provider Letters OHCA-2007-46 and OHCA-2007-50 for complete details.

3/12/2008

Provider Changes of Address

Title: Provider Changes of Address

Run Date: 03/12/2008 – 04/26/2008

PV Types: All

Message:

OHCA must be notified when you experience a change of address in either your physical and/or your mailing address locations.  Mail returned to OHCA as undeliverable causes your provider contract(s) to be placed on hold which results in the suspension of your reimbursement payments.

To avoid delays in receiving your payments and provider updates, please notify OHCA in writing immediately when you have an address change.

Please send your address change notifications to:

OHCA, Provider Enrollment, PO Box 54015, Oklahoma City, OK 73154.

3/6/2008

NDCs

Title: NDCs

Providers: All

Run Dates: 03/06/2008 – 04/30/2008

Message:

When you experience a problem in billing with a particular NDC number, please have that NDC number exactly as it appears on the vial or package, including the hyphens, available before you call the OHCA Call Center. The OHCA Call Center staff cannot provide the NDC number to be used for billing drugs on medical claims. The OHCA Call Center staff will then be able to assist you in putting the NDC in the proper format. 

If you do experience these problems please call the OHCA Call Center at (800)522-0114 – Option #1, or, locally in OKC at (405)522-6205 – Option #1.

2/25/2008

Admissions Policy

Title: Admissions Policy

Run Date: Feb 22 – Apr 10, 2008

Providers: 01 – Hospitals

Message:

Referrals for Inpatient Hospital Admissions are no longer required from the member’s Primary Care Physician for claims filed after 02/21/2008.

2/13/2008

Clarification – OHCA 2008-03 Letter

Title: Clarification – OHCA 2008-03 Letter

Providers Type: 01 - Hospitals

Run Date: 02/13/2008  thru: 04/01/2008

Message:

This is to clarify information provided in OHCA 2008-03 Dear Provider Letter.

Adult therapies in an outpatient hospital setting are limited to 15 visits per calendar year per discipline.

02/07/2008

Category II and III CPT Codes

Title: Category II and III CPT Codes

Providers: All

Run Dates: 02/11/2008 – 03/26/2008

Message: Category II HCPC Codes are used for supplemental tracking for performance measures. Category III HCPC Codes are temporary codes for emerging technology, services and procedures.

There is no reimbursement value associated with these  Category II and III HCPC Codes.

01/30/2008

CPT Code 99360

Title: CPT Code 99360

Run Date: 01/30/2008 – 03/15/2008

Providers: All

Message: CPT Code 99360 has been assigned a Relative Value. OHCA has updated our fee schedule to add this code to the RBRVS fee schedule. Claims filed with DOS after 01/01/08 will be paid $41.64.

If you have any questions please contact provider services at 1-877-823-4529. Thank you.

01/25/2008

Diabetic Supplies

Title: Diabetic Supplies

Provider Types: All

Run Dates: 01/25/2008 – 03/10/2008

Message: Diabetic supplies: Limits for the number of test strips and lancets without a prior authorization have been increased to a maximum of 200 glucose test strips and 200 lancets per month when medically necessary and prescribed by a physician. Diabetic supplies in excess of these parameters must be prior authorized.

01/25/2008

Blood Lead Testing

Title: Blood Lead Testing

Run Dates: 01/25/2008 – 03/10/2008

Provider Types:

31 – Physicians

88 – Pediatric Clinic

90 – Pediatric Nurse Practitioner

100 – Physician Assistant

345 – General Pediatrician

Did you know?

  1. SoonerCare Pays for Blood Lead testing -Procedure Code 83655

  2. Blood lead screening tests (by either finger stick or venipuncture) must be performed between the ages of 9 and 12 months and at 24 months during the regular child health checkup.

  3. A blood lead test is required for any child who has not been previously screened up to age 72 months.

  4. A blood lead test equal to or greater than 10 micrograms per deciliter (ug/dL) obtained by capillary specimen (finger stick) must be confirmed using a venous blood sample.

  5. If a child is found to have blood lead levels equal to or greater than 10 ug/dL, the Oklahoma Childhood Lead Poison Prevention Program (OCLPPP) must be notified according to rules set forth by the Oklahoma State Board of Health. 1-800-766-2223 or 405-271-6617

  6. If you have any question please call the Child Health Unit at 405-522-7188

01/07/2008

Audiology Pricing

Title: Audiology Pricing

Run Dates: 01/07/2008 – 02/25/2008

Providers: Type 20; Spec 200 (Audiologists)

Message: Effective February 1, 2008, pricing on the codes listed below will change.

V5254 - $498.13

V5255 - $481.25

V5256 - $487.50

V5258 - $956.40

V5259 - $840.00

V5260 - $840.00

Thank you.

01/07/2008

Browser Compatibility

Title: Browser Compatibility

Run Date: 01/04/2008 – 04/30/2008

PV Types: ALL

Message: Effective 01/15/08, the OHCA Secure website will only support Internet Explorer version 6.0 or higher. For further inquiries please contact the Provider Secure Site Helpdesk at 1-800-522-0114, option 2, and then option 1.