Global Messages

/images/web_alerts.jpg

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 

8/11/14 Balance Billing of Members

Title:       Balance Billing of Members 

Run Date:    08/11/2014 – 09/26/2014 

PV Type:     All 

Providers cannot bill or attempt to collect payment from a SoonerCare Member for any covered service, other than co-payments allowed by The Oklahoma Health Care Authority (OHCA). 

Pursuant to 42 CFR 447.15, payments made by OHCA shall be considered payment in full, except for OHCA allowed Member co-payments. This provision is a part of all SoonerCare contracts and applies even if the provider elects not to bill OHCA for a covered service.   

Any questions or concerns regarding balance billing should be directed to Provider Services at 800-522-0114, option 1, before billing the member. 

8/7/14      SUD Treatment Requirements  

Title:   SUD Treatment Requirements 

Run Dates:   08/04/2014 – 09/19/2014 

PV Types:    11 

    SPC:     110, 118, 123 

Pursuant to State law, only facilities appropriately certified by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) may receive and assist alcohol and drug-dependent persons by providing treatment, recovery support and rehabilitation. Organizations without proper certification may not provide treatment services to clients with substance use disorder service focus. Any claims for SUD treatment services provided by non-certified organizations are subject to recoupment. For questions related to ODMHSAS certification please contact Brenda Pitts at bpitts@odmhsas.org or 405-522-3800.  

8/4/2014 Blood Glucose Testing Supplies  

Title:       Blood Glucose Testing Supplies 

Run Date:    08/01/2014 – 09/30/2014 

PV Types:    ITU – 07/072, 08/084 

             DME – 250 

             Physician – 31 

             Tribal Hospitals – 01/016 

Physicians who are treating members with pre-diabetes symptoms may prescribe blood glucose (BG) testing supplies in accordance with the member’s treatment. Dispensing providers would need to obtain a prescription with the DX code of 79029 (Other Abnormal Glucose). Supply limits for this group are identical to those for members who are diagnosed with Type 2 diabetes: two (2) boxes of 50 BG strips and one (1) box of 100 lancets per quarter. 

7/28/2014 Telephone Number Clarification re: Provider Letter 2014-13    

Title:    Telephone Number Clarification re: Provider Letter 2014-13 

Run Date: 07/25/2014 – 09/10/2014 

PV Types: 170-Physical Therapy, 171-Occupational Therapy, 173 & 182-Speech Language Pathology, and, 200-Audiology Providers 

The telephone number specified originally in Provider Letter 2014-13, [Therapy-Related Parental Participation – Effective Date 08/01/2014] has been updated.  

The new number to call with any questions is (888) 693-3281, option 2. Thank you.

7/22/2014 WEBINAR: HOW TO SUBMIT A DENTAL PA ON THE PROVIDER PORTAL 

Title:         WEBINAR: HOW TO SUBMIT A DENTAL PA ON THE PROVIDER PORTAL 

Run Date:      07/22/2014 – 08/07/2014 

PV Types:      27 – Dentist 

                    86 – Dental Clinic 

                    271 – General Dentistry 

                    272 – Oral Surgeon 

                    273 – Orthodontist 

                    274 – Pediatric Dentist 

OHCA will be conducting a WEBINAR on August 6, 2014 to review the process of submitting Dental PA’s on the Provider Portal. This class will discuss the PA process, the forms required, how to complete the forms properly and what records will be required.   

Please register via link below: 

Class Time:  August 6, 2014 @ 2:00 pm 

Registration:  http://www.okhca.org/providers.aspx?id=110&parts=7557_7559 

Please share this notification with any dental provider!   

7/15/2014 Insure Oklahoma Copays  

Dear Insure Oklahoma Individual Plan Provider, 

  

This letter is to review the copays for individuals covered by the Insure Oklahoma Individual Plan. As of January 1, 2014, co-pays for prescriptions, physician, and outpatient visits were changed. Most copays are now $4, although some prescriptions and durable medical equipment (DME) are $8. The emergency room co-pay remains the same at $30 and is waived if the member is admitted. Current co-pays are as follows: 

  

Service 

Co-pay Amount 

Behavioral health and substance abuse services  

$4 copay per visit 

Diabetic supplies 

$4 copay per prescription 

Durable medical equipment and supplies 

$8 co-pay for DME equipment (hospital beds, wheelchairs, and walkers) ; $4 co-pay for durable, non-durable supplies (e.g. tubing, bandaids, and masks) 

Home health care services 

$4 copay per visit 

Immunizations 

$4 copay per visit 

Laboratory and X-ray 

No copay for standard radiology ($4 co-pay per specialized scan - MRI, MRA, PET, CT) 

Outpatient hospital and surgery services 

$4 copay per visit 

Physician services 

$4 copay per visit 

Prescription drugs 

$4 copay for generic - $8 co-pay for brand name 

Substance Abuse Treatment (medical detoxification only) 

Outpatient - $4 per visit 

Therapy services - Physical, Speech, Occupational 

$4 copay per visit 

Vision services 

Coverage for eye diseases or eye injuries only - $4 copay 

For dates of service on or after January 1, 2014, IO IP members are responsible for paying all individual co-pay amounts for the aforementioned services. Please review the remittance advice for total member co-pay amounts due. These changes will not affect claims for dates of service rendered prior to January 1, 2014.   

Thank you for your continued service to Insure Oklahoma members. If you have questions, please contact the Insure Oklahoma helpline at (888) 365-3742. 

7/15/2014 Prior Authorization Webinar for Spinal Fusion Surgery    

Title:    Prior Authorization Webinar for Spinal Fusion Surgery 

Run Date: 07/15/2014 – 07/24/2014 

PV Type:  31-Physician; 01-Hospital 

SPC:   325 Neurological Surgeon 

342 Thoracic Surgeon 

544 Pediatric Orthopedics 

551 Pediatric Surgery (Neurology) 

559 Surgery Head and Neck  

010 Acute Care 

015 Children's Specialty   

  

Attention:   Neurosurgeons, Orthopedists and Inpatient Hospitals 

Effective, July 2014, a new process will be implemented regarding the PA process for Inpatient Spinal Fusion Surgery.  We will be conducting webinars to go over the new process on July 22 and July 24.  This class will discuss the PA process, the forms required, how to complete the forms properly and what records will be required.   

**Attendees only need to register for one webinar. 

Class Times:  July 22, 2014    2:00 p.m. 

                   July 24, 2014    2:00 p.m. 

Registration: http://www.okhca.org/providers.aspx?id=110&parts=7557_7559 

7/10/2014 Psychosocial Rehabilitation Services Eligibility  

Title: Psychosocial Rehabilitation Services Eligibility 

Run Date:  07/10/2014 – 09/30/2014 

PV Types:  110, 111, 118, 123 

  

Effective August 1, 2014, eligibility criteria changes for psychosocial rehabilitation services (PSR) offered through SoonerCare.  

 

Adult PSR services will be limited to members who: 

·         have a history of psychiatric hospitalization or admissions to crisis centers;  

·         have been determined disabled by the Social Security Administration for mental health reasons; 

·         are residing in residential care facilities; or  

·         are receiving services through a specialty court program.  

  

Children's PSR services will be limited to members who have: 

·         a history of psychiatric hospitalization or admissions to crisis centers;  

·         been determined disabled by the Social Security Administration for mental health reasons;  

·         a current Individual Education Plan (IEP) or 504 Plan for emotional disturbance; or  

·         been evaluated by a school psychologist, licensed psychologist, or psychiatrist and determined to be "at risk.”  

 

Guidance regarding prior authorization requirements for these services will be provided in the next couple of weeks. The Prior Authorization Manual will be updated to include the new processes and added to the OHCA website (http://www.okhca.org) August 1. 

7/2/2014 School-Based Fee Schedule 

Title:   School-Based Fee Schedule 

Run Date:    07/02/2014-08/17/2014 

PV Types:    12 / SPC 120 

   

Effective 7/1/2014 School-Based billing rates have changed. 

Review the updated fee-schedule rates on the OHCA website at:   http://www.okhca.org/providers.aspx?id=566  

7/1/2014 OXYGEN PA Postponed until 8/1/2014

Title:      OXYGEN PA Postponed until 8/1/2014 

Run Date:   07/01/2014 – 10/01/2014 

PV Types:   250 – DMEPOS Providers 

  

Oxygen equipment and services will require PA effective August 1, 2014. OHCA has determined that prior authorizations will not be required for residents of nursing facilities or Insure Oklahoma members; however, the modifier instructions below apply to all claims.    

All claims with dates of service before July 31, 2014 will require the use the “LL” modifier for oxygen equipment rental. HCPCS codes include E0424, E0431, E0434, E0439, E1390, E1391, E1392, and K0738.  The modifier “RR” will be used beginning August 1, 2014.   

No prior authorizations for OXYGEN will be accepted by the OHCA system prior to August 1, 2014. 

Provider letters detailing these changes are forthcoming. 

If you have additional questions, please contact DME Director Stan Ruffner at stan.ruffner@okhca.org or 405-522-7924. 

6/30/2014 Proposed Budget Cuts & Their Effective Dates

TITLE:    Proposed Budget Cuts & Their Effective Dates 

Run Dates:    06/27/2017 – 08/15/2014 

PV Types:     All 

 

Elimination of Perinatal Dental Benefits (cited in OHCA Member Letter 2014-02)

* effective Jul 18 

Prior Authorize Oxygen after 90 days * exclude nursing homes  

* effective Aug 1 

Convert Blood Glucose supplies to competitive bid national rate    

* effective Jul 1 

Exclude Members with other primary credible insurance from Medical Homes  

* effective Jul 1 

Federally Qualified Health Centers / Rural Health Centers Visit Limit;  

4 per month for adults; 1 per day for everyone  

* effective Jul 1 

Hospital Readmissions  

* effective Oct 1 

Prior Authorization for all Sleep Studies  

* effective Aug 1 

Prior Authorization for all Back & Spinal Surgeries  

* effective Aug 1 

Limit number of pairs of glasses we pay for children to 2 pair / year  

* effective Jul 1 

Increase Copays; most $3 copays are going to $4;  

Rx $0 copay generics are also going to $4  

* effective Jul 1 

Eliminate payment for hospital leave days to nursing facilities  

* effective Jul 1 

Reduce payment of co-insurance on Part B crossover claims from  

100% to 46.25%  

* effective Jul 1 

Across the board rate reduction of 7.75%  

* effective Jul 1 

  

These reductions do not apply to the Insure Oklahoma Program. 

  

If you have questions please call the OHCA Call Center at (800)522-0114. 

6/30/2014 NH Only Cost Share Reporting

Title:       NH Only Cost Share Reporting 

Run Date:    06/27/2014 – 07/02/2014 

PV Type:     Nursing Homes:  

             03-Extended Care Facility 

SPC: 

030 

Nursing Facility 

031 

ICF/MR > 6 Beds 

032 

Pediatric Nursing Facility 

033 

Residential Care Facility 

034 

ICF/MR < 6 Beds 

035 

Skilled Nursing Facility 

036 

Respite Care - Facility Based 

037 

Assisted Living 

  

Attention NH Facilities: 

Effective July 2014, a new process will be implemented in the Provider Portal regarding the submission of Cost Share Reporting to the Oklahoma Health Care Authority.  In this class, we will discuss changes to the Cost Share Reporting for Long Term Care (LTC) Providers.  We will cover how to access the site and the various changes in the actual reporting process. **-Attendees only need to register for one webinar 

Class Times:*  July 1, 2014                 10:00 a.m.

Registration:  http://www.okhca.org/providers.aspx?id=110&parts=7557_7559 

6/30/2014 CLARIFICATION: Manually Priced Items - Process Postponed until 10/1/2014 

Title:            CLARIFICATION: Manually Priced Items –  

Process Postponed until 10/01/2014  

Run Date:         07/01/2014-10/31/2014  

PV Types:         250 – DMEPOS Providers  

   

Manually Priced Items   

Due to administrative delays, the current processing method for manually priced items will continue to be in effect until October 1, 2014.  Please continue to provide pricing information with your PA requests, if appropriate, or submit costs with your claims as you do now.   

Provider Letters:  A provider letter detailing these changes is forthcoming.   

If you have additional questions, please contact DME Director Stan Ruffner at stan.ruffner@okhca.org or 405-522-7924.   

6/18/2014 NH Only Cost Share Reporting  

Title:       NH Only Cost Share Reporting 

Run Date:    06/18/2014 – 08/02/2014 

PV Type:     Nursing Homes:  

             03-Extended Care Facility 

SPC: 

030 

Nursing Facility 

031 

ICF/MR > 6 Beds 

032 

Pediatric Nursing Facility 

033 

Residential Care Facility 

034 

ICF/MR < 6 Beds 

035 

Skilled Nursing Facility 

036 

Respite Care - Facility Based 

037 

Assisted Living 

Attention NH Facilities: 

Effective July 2014, a new process will be implemented in the Provider Portal regarding the submission of Cost Share Reporting to the Oklahoma Health Care Authority. In this class, we will discuss changes to the Cost Share Reporting for Long Term Care (LTC) Providers. We will cover how to access the site and the various changes in the actual reporting process. **-Attendees only need to register for one webinar.

Class Times:*  June 26, 2014 at 10 a.m.  

                     June 26, 2014 at 2 p.m. 

                     June 27, 2014 at 10 a.m.           

Registration:  http://www.okhca.org/providers.aspx?id=110&parts=7557_7559 

6/17/2014 Clarification to BH Providers

Title: Clarification to BH Providers 

Run Date: 06/17/2014 – 07/31/2014 

PV Type: 08, 11, 53 

Spc: 110, 111, 112, 115, 121, 193, 585, 535, 536 

The RBRVS global dated June 12, 2014 mentioned the 7.75% rate reduction. For Behavioral Health services this reduction only applies to psychiatrists and Inpatient Facility Psych Beds which are paid off of the DRG fee schedule. 

6/12/2014 New Fee Schedule  

Title: New Fee Schedule 

Run Date: 06/12/2014 – 07/31/2014 

PV Types: All 

Remember that we update our fee schedule every July to rebase to the new Medicare RVUs. The new fee schedule will be on our public website as soon as possible.  

Dates of service prior to July 1, 2014 are paid at last year’s rate and dates of service after July 1, 2014 are paid at the new rate. The new fee schedule will also reflect the agency’s across the board rate reduction of 7.75%.

6/12/2014 DME Changes Effective 07/01/2014 - Blood Glucose Supplies  

Title: DME Changes Effective 07/01/2014 - Blood Glucose Supplies 

Run Date:   06/12/2014-07/31/2014 

PV Types:   250 – DMEPOS Providers 

Blood Glucose Supplies 

OHCA will cover blood glucose (BG) supplies for members who are being treated with insulin to allow a maximum of 100 per month. Coverage for BG supplies for members who are not treated with insulin will be limited to 100 per a 90 days.  In addition, OHCA will cover BG supplies for members who are diagnosed with gestational diabetes, with a maximum allowable of 150 per month. Rates will be adjusted to national competitive bid rates.  

If additional supplies are needed, BG supplies are eligible for prior authorization (PA) override if documentation of medical necessity is provided to the Medical Authorization Unit.  

Provider Letters -   A Provider letter detailing this change is forthcoming. 

If you have additional questions, please contact DME Director Stan Ruffner at stan.ruffner@okhca.org or 405-522-7924 

6/12/2014 DME Changes Effective 07/01/2014

Title: DME Changes Effective 07/01/2014 

Run Date:   06/12/2014-07/31/2014 

PV Types:   250 – DMEPOS Providers 

Budget Impact – After thoughtful consideration, the agency has determined that an across-the-board rate reduction is required to balance the budget for the upcoming fiscal year.  Therefore, a reduction rate of 7.75% will be applied to all DME products. 

Manually Priced Items 

OHCA will price items that do not have a set max fee rate, also known as manually priced items, by examining the MSRP plus the invoice and paying the lesser of MSRP -30 percent or cost +30 percent for those items.  It will be necessary for the provider to include a copy of the invoice, MSRP and proof of delivery along with the claim when submitting for payment. In addition, the 7.75% Budget Reduction rate reduction will be applied to the claims for manually priced items. 

Oxygen 

Oxygen equipment and services will require PA effective July 1, 2014.  All claims after July 1, will require a new modifier RR  (continuous rental) for oxygen rental. HCPCS codes include E0424, E0431, E0434, E0439, E1390, and E1391. 

Provider Letters -  Provider letters detailing these changes are forthcoming. 

If you have additional questions, please contact DME Director Stan Ruffner at stan.ruffner@okhca.org or 405-522-7924 

6/2/2014 Medication/Pharmacy PAs

Title: Medication/Pharmacy PAs 

Run Dates:   05/30/2014 – 06/30/2014 

PV Types:    All 

Medication/pharmacy prior authorizations (PAs) should NOT be submitted via the provider portal; they will NOT be processed.  To properly submit, please visit www.okhca.org/rx-forms to make your PA request, whether the drug is to be dispensed at a pharmacy or administered by a physician.  

5/27/2014 Allergen Coding/Payments

Title: Allergen Coding/Payments 

Run Dates:   05/27/2014 – July 15, 2014 

PV Types:    All 

Effective immediately, OHCA will no longer reimburse for CPT codes 86001 (Allergen specific IgG quantitative or semiquantitative, each allergen) or 86005 (Allergen specific IgE: qualitative, multiallergen screen) in accordance with CMS guidelines.  

Effective 6/1/2014, OHCA will no longer reimburse for CPT codes 95120 (provision of allergenic extract; single injection), 95125 (2 or more injections), 95130 (single stinging insect venom), 95131 (2 stinging insect venoms), 95132 (3 stinging insect venoms), 95133 (4 stinging insect venoms) and 95134 (5 stinging insect venoms) in accordance with CMS guidelines.   

5/22/2014 Oximeter Rates Increase in July 2014  

Title: (E0445) Oximeter Rates Increase in July 2014   

Run Dates:  05/23/2014 – 07/07/2014 

PV Types:   250 – DMEPOS Providers 

The rate for E0445 (Oximeter Device) for measuring blood oxygen levels non-invasively, with rental episodes, will be changed from $120.94 to $193.50 for dates of service after July 1, 2014.  This rate increase includes the oxygen probes (A4606) for use with the Oximeter Device during the rental period. After the rental period is completed, additional probes may be obtained (up to a limit of 4 per month) if prior authorized. 

5/19/2014 CPT Code 95165

Title: CPT Code 95165 (Preparation of vials for non-venom antigen) 

Run Date: 05/15/2014 – 07/01/2014 

PV Types: All 

Effective 06/01/2014, reimbursement for CPT code 95165 (preparation of vials for non-venom antigen) will be limited to ten (10) doses per multi-dose vial, in accordance with CMS guidelines.  If two multi-dose vials are used, provider may bill no more than 20 doses. If less than 10cc aliquot from multi-dose vial is used, provider may bill only for number of 1cc aliquots.  

5/1/2014 Therapy Management Program

Title: Therapy Management Program

Run Date: 04/30/2014 – 06/15/2014

PV Types: 170-Physical Therapy, 171-Occupational Therapy, 173 & 182-Speech Language Pathology, and, 200- Audiology Providers

Message:

The Oklahoma Health Care Authority (OHCA) continues to implement quality initiatives to support your patient care efforts for SoonerCare and Insure Oklahoma members. In line with this goal, the OHCA is implementing a therapy management program (TMP) for occupational therapy (OT), physical therapy (PT) and speech therapy (ST) in partnership with “MedSolutions and its affiliate Triad Healthcare” (“MedSolutions”), an organization that specializes in managing therapy-related services.  This new process will allow the OHCA to assist our providers and members in obtaining the most appropriate therapy-related service and improve access to high quality, cost effective care in a timely manner.

For all OT, PT and ST services performed on or after July 1, 2014, treating providers will submit prior authorization requests (PARs) to MedSolutions.

PARs can be submitted through a secure internet web portal: www.triadhealthcareinc.com/soonercare, or faxed toll-free: (888) 328-3662. For telephonic inquiries, Triad Healthcare’s toll-free number is: (888) 693-3281.

To help with this transition, MedSolutions will be hosting webinar sessions at various times/dates. These sessions will provide you with all the information required for prior authorization and identify issues that may prevent you from obtaining a timely determination.  For more information about participating in one of these webinars, please visit www.triadhealthcareinc.com/soonercare.

Because MedSolutions has a proven history of providing quality evidenced based review for therapy-related services, OHCA will be accepting their guidelines for use with all prior authorization reviews.  MedSolutions will, however, continue to follow all of the OHCA’s general program requirements and payment/policies, including the current requirements for OT, PT and ST PARs (i.e. OT and PT evaluations may still be performed without prior authorization; however, ST evaluations must be prior authorized prior to rendering services).

MedSolutions is capable of processing all PARs within two (2) business-days; therefore, the 30-day Retro Rule will no longer apply and all OT, PT and ST services must be approved prior to rendering services. The one exception to the exclusion of the 30-Day Retro Rule will be for the month of July 2014.  During this one-month period, after MedSolutions has begun processing therapy-related PARs for the OHCA, the 30-Day Retro Rule will remain in effect, ending on July 31, 2014.

Although school-based services are currently excluded from these changes, please be aware that in the coming months, the above-listed changes will apply to school-based services.  Additional information will be released prior to implementing these changes for school-based services.

Thank you for the quality care that you provide to SoonerCare and Insure Oklahoma members.  If you have questions, please contact the OHCA Medical Authorization Unit at 800.522.0114 or visit our website at www.okhca.org.

4/28/2014 Adult Coverage For Optometry Services

Title:  Adult Coverage for Optometry Services

Run Date: 04/23/2014 – 06/04/2014

PV Types: 18 Optometrist, 19 Optician
Spc:  180 Optometrist, 190 Optician, 330 Opthamologist

Adult Coverage for Optometry Services:
Payment can be made for medical services that are reasonable and necessary for the diagnosis and treatment of illness or injury up to the patient's maximum number of allowed office visits per month.

There is no provision for routine eye exams, examinations for the purpose of prescribing glasses or visual aids, determination of refractive state, treatment of refractive errors, or purchase of lenses, frames, or visual aids. Payment is made for treatment of medical or surgical conditions which affect the eyes.

4/22/2014 HMO Copays on the New 1500 Claim Forms

Title: HMO Copays on the New 1500 Claim Forms

Run Date: 04/21/2014 – 06/07/2014

PV Types: All

To assist in the proper payment of HMO co-pay claims, the co-pay amount due should be entered in Block 24F and Block 29 on the “new”1500 form; failing to do so will result in a denial.

On the UB-04 form enter the co-pay amount in Block 47, the TOTALS block and Block 55B.

Please include the EOB or Roster with the corresponding co-pay. HMO co-pays should be filed for fully capitated plans only, not a PPO or Medicare Advantage Plan. These claims must be submitted on paper and mailed to: HP, PO Box 18500, Oklahoma City, OK 73154

4/18/2014 OHCA’s Position on ICD-10 Delay

OHCA’s Position on ICD-10 Delay

On Tuesday, April 1, 2014, President Obama signed Congressional Bill HR 4302 into law which delays the implementation of ICD-10 by at least one year, to October 1, 2015.  As a result of the delay, the Oklahoma Health Care Authority will continue to accept only ICD-9 codes and deny any ICD-10 codes submitted on a claim until the Secretary of Health and Human Services formally adopts ICD-10 as the new ICD code set standard.

While the implementation of ICD-10 has been delayed, external testing with providers is still a top priority. Before defining the testing schedule however, OHCA is awaiting guidance from CMS regarding the delay. Once the testing schedule is finalized, it will be communicated accordingly.

4/14/2014 OP Surgery Referrals

Title:  OP Surgery Referrals

Run Date: 04/10/2014 -05/29/2014

PV Types: All

In the previous referral system a specialist could use the referral from the SoonerCare Choice Primary Care Provider as approval for OP surgery that a member might need. Because of the unique way our electronic referrals are set in the system this passing along of a referral for OP services is not allowed. If the specialist feels the member needs OP surgery NO referral for the facility will be required. We have modified our system to bypass the referral requirement for OP surgery facility claims. If you have any additional questions please call the OHCA call center at 1-800-522-0114. 

4/10/2014 2014 Provider Workshop – Enid Closing

Title: 2014 Provider Workshop – Enid Closing

Run Date: 04/09/2014 – 04/17/2014

PV Types: All

Registration for the April 17, 2014 Spring Workshop for Enid will close on Thursday, April 10th at 5 p.m. Registration for locations in OKC and Tulsa are still available.

Each attendee must register individually.  Please carefully read the class descriptions and recommended audiences before choosing your classes. Register today!

Information and registration is available at:

Class Descriptions: http://www.okhca.org/Classes  

Registration Tool: http://www.okhca.org/Register 

To make changes to your registration, please call 405.416.6730 or email HPokxixTraining@hp.com.

3/31/2014 STBS-M (SOON TO BE SOONER MAINTENANCE OF EFFORT)

Title:  STBS-M (SOON TO BE SOONER MAINTENANCE OF EFFORT)

Run Date: 03/31/2014 – 05/15/2014

PV Types: 
31 Physician
091 OB Nurse Practitioner
181 Maternity
199 OB/GYN Group
214 High Risk Pregnant  Women
316 Family Practitioner
318 General Practitioner
328 Obstetrician/Gynecologist
335 Maternal Fetal Medicine
564 Primary Care Provider


It has come to our attention that Prior Authorization Requests (PARs) for SoonerCare members with the eligibility category of STBS-M have been auto-denying as no active benefits or not in active service.

If you have submitted a PAR for High Risk OB (HROB) services or Diabetic Supplies for an STBS-M member and received an auto denial, please contact us so the PAR can be manually processed.

Providers will need to call the main OHCA call center at 1-800-522-0114 and inform the call center representative that you have a PAR for HROB services or Diabetic Supplies, which auto-denied on an STBS-M member. The representative will then transfer you to the Medical Authorization Unit (MAU), at which time you will be prompted to leave a detailed message.  An MAU representative will research the request and return your call within one (1) business day. 

When prompted to leave a message, please provide the following information.

• Call Tracking Number
• Prior Authorization Number
• Member Name & RID
• Provider Contact Name & Phone Number

We thank you for your patience while the system is updated.

2/26/2014 Electronic Referral Modifications

Title:  Electronic Referral Modifications

Run Date: 03/25/2014 – 05/10/2014

PV Types: All

We are making modifications to the electronic referrals in the new SoonerCare Provider Portal. Because it needs additional modifications, both forms of referrals, electronic and paper, will be acceptable. Claims will process based on either form being used.

If the service you are addressing requires a Prior Authorization, this global message does not apply to your circumstance and an electronic referral or SC-10 form is not required for the Prior Authorization review. 

We will let you know when only electronic referrals are to be used to request services.

3/24/2014 2014 Spring Provider Training Workshop

Title:  2014 Spring Provider Training Workshop

Run Date: 03/21/2014-05/16/2014

PV Types: All

PLEASE JOIN US FOR THE 2014 SPRING PROVIDER TRAINING WORKSHOP!
You and your staff are encouraged to attend the Spring 2014 SoonerCare Provider Training Workshops hosted by the Oklahoma Health Care Authority (OHCA) and HP Enterprise Services. Classes offered will be Electronic Health Records (EHR), SoonerCare audits, Adjustments/Third Party Liability (TPL), Durable Medical Equipment (DME), and a class that will highlight the key features utilized on the new provider portal. These workshops will be held in 4 locations, beginning April 10th.

Register today!

Information and registration is available at: 

Durant, OK will be the first stop on April 10 followed by: Enid, April 17; Tulsa, April 30-May 1; and, conclude in Oklahoma City, May 14–15.

3/13/2014 REMINDER: New Paper 1500 Claim Forms

Title: REMINDER: New Paper 1500 Claim Forms

Run Dates: 12/20/2013 – 03/31/2014 extented through 04/30/2014

PV Types: All

OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.

3/7/2014 Submission of Dental PA’s

Title:  Submission of Dental PA’s

Run Date:  03/06/2014 – 04/21/2014

PV Type:  27 – Dentist
   Spc:  86 – Dental Clinic
   271 – General Dentistry
   272 – Oral Surgeon
   273 – Orthodontist
   274 – Pediatric Dentist

MESSAGE:

For all dental providers:

When submitting a Dental Prior Authorization request, we are unable to accept zip files.  Only JPEG, TIF, and PDF files are allowed. We appreciate your patience cooperation in this matter!

2/5/2014 CM II Training

Title:  CM II Training

Run Date: 03/05/2014 – 04/01/2014

Pv TYPES: 11

Children's Certificate in Psychiatric Rehabilitation In-Person Course:

Resiliency and psychiatric rehabilitation services are invaluable to children and their families. Increase your abilities and knowledge as a youth services practitioner by earning your Certificate in Children’s Psychiatric Rehabilitation (20 contact hours).

Children's Certificate in Psychiatric Rehabilitation - Oklahoma City, OK

March 10-12, 2014

Best Western Saddleback Inn and Conference Center, 4300 Southwest Third Street, Oklahoma City, OK 73108

Members: $495; Non-Members: $595 (Join Today)


http://www.uspra.org/certification/childrens-certificate 

3/5/2014 CPT Code 92250

Title: CPT Code 92250

RUN DATES: 03/05/2014 – 04/20/2014

PV Types: All

Effective 3/1/2014, CPT 92250 (fundus photography) is not covered for routine screening or typical refractive error diagnosis and is limited to one service annually.

2/27/2014 CPT Codes 65093 & 65105

Title:  CPT Codes 65093 & 65105

RUN DATES: 02/27/2014 – 04/15/2014

PV Types: All

Effective 1/1/2014, CPT 65093 (Evisceration of Ocular contents, with implant) and CPT 65105 (Enucleation of eye, with implant, muscles attached to implant) age restrictions have changed to 0-999 years.

2/26/2014 Clarification – Submitting PAs via the Provider Portal

Title: Clarification – Submitting PAs via the Provider Portal

Run Date: 02/26/2014 – 04/15/2014

PV TYPES: All

Clarification Regarding Prior Authorizations Requests (PARs) via the Provider Portal:

We have become aware that during recent Provider Training addressing the new Provider Portal, confusion was created regarding the PA Process handled by the Medical Authorization Unit (MAU).

The process for submitting a PAR to the MAU has not changed. We require the same information to be submitted, regardless of whether the request is submitted via fax or using the Provider Portal.

Required documentation:
If you are entering a PAR via the Provider Portal, you will still need to submit the following:
1. HCA-12A or a copy of the on-line PA Authorization screen or you may save a copy of this screen as a WORD document and attach it to the PA when you are uploading your documentation (The MAU staff are not able to view this information in our PA Workflow System).

For High Risk OB requests, the completed CH-17 form is still required.

Therapy PARs: The rendering/servicing provider should be the individual provider ID# or NPI of the therapist who will provide the services. Claims will not pay if a group ID is listed, as the individual licensed professional must file the claim.

2. The MAU requires a script or order from the treating provider for ALL PARs.

3. CMN (Certificate of Medical Necessity): If required, please see the section regarding Forms.

4. Required documentation: Please refer to the individual sections on the OHCA Public Webpage for pertinent information (www.okhca.org, Providers, Medical Authorization Unit, scroll to the necessary section, click to view information).

5. Photos can be scanned and upload in the same manner as uploading documents. Unfortunately, videos still require delivery via mail service.

We encourage you to use the Provider Portal to submit your PARs with the uploaded documents, as this reduces the potential for problems we have experienced in the past with providers faxing documents, especially legibility issues. For further information, please contact the MAU @ (800) 522-0114.

2/25/2014 2014 EHR Documents Email Available

Title: 2014 EHR Documents Email Available

Run Date: 02/25/2014 – 06/30/2014

PV Types: 01- Hospital, 31- Physicians, 52- State Employed Physicians, 09- Advance Practice Nurse, 27- Dentist, 10– Mid-level Practitioners

OHCA is now accepting email for patient volume documentation files at EHRDocuments@okhca.org. When sending the email, please include the provider’s name, NPI and ATN from the fax coversheet in the subject line. All emails should be sent securely when sending PHI. Please note the email is only to be used for patient volume documentation, you will still need to fax in the fax coversheet, signature page, vendor letter and meaningful use report to the fax number provided on the coversheet.

Reminder:  The end date to submit your 2013 reporting year attestations is March 31st, 2014.

2/19/2014 Electronic Referral System Available Through the Portal

Title: Electronic Referral System Available Through the Portal

Run Date: 02/18/2014 – 04/03/2014

PV Types: All

As we are moving from paper referrals to the electronic referral system available through the portal, please keep in mind that the new system was only designed to replace the SC-10 form (paper referrals). The new referral will allow OHCA to track specialty utilization and allow claims to process. You will need to continue to send  additional information that was requested from the specialist. This includes contact information for the members, face sheets, office notes etc. for continuum of care, for these members. Also, please note when submitting a new referral from the new provider portal, PCP’s should confirm the related NPI and address of the specific specialist that is being referred to.  OHCA and HP are still reviewing ways to improve this new process. In conclusion, at this time paper referrals are still accepted through March 31st 2014.  

2/10/2014 2014 Spring School-Based Training Schedule

Title: 2014 Spring School-Based Training Schedule

Run Date: 02/10/2014 – 04/04/2014 PV Types: 12 Spc: 120

School-Based Training is scheduled for the following dates and times.

March 5, 2014 – McAlester (10:00 am to 12:00pm)
March 6, 2014 – Stillwater (10:00am to 12:00pm)
March 10, 2014–  Oklahoma City (10:00am to 12:00pm)
April 1, 2014– Poteau (1:00pm to 3:00pm)

Register for training through OHCA website at
http://www.okhca.org/schoolbased 

2/5/2014 Claims Submissions Extension

Title:  Claims Submissions Extension
Run Date: 02/05/2014 – 03/20/2014
PV Type:  All


Please be advised that due to issues regarding the new OHCA provider portal, we will allow claims submissions up to 12:00 PM on Thursday 02/06/2014.  There will be no impact to the payment date. 

Thank you for your support as we continue to work through the issues related to the provider portal

1/30/2014 School Based Fee Schedule

Title: School Based Fee Schedule

Run Date: 01/30/2014 – 03/15/2014

PV Types: 12  - School Corp Spc:  120 – School Corp


Effective January 1, 2014 the School Based Fee Schedule has changed in regards to speech language evaluations

Review the updated fee-schedule on the OHCA website at

http://www.okhca.org/providers.aspx?id=566 

1/28/2014 Provider Portal / Claims Submissions

Title: Provider Portal / Claims Submissions

Run Date: 01/28/2014 – 03/15/2014

PV Types: All

Please be advised that due to issues regarding new OHCA provider portal, we will allow claims submissions up to 5:00 PM on Friday 01/31/2014.  There will be no impact to the payment date.  Thank you for your support as we continue to work through the issues related to the provider portal.

1/16/2014 2014 EHR Attestations Now Available

Title: 2014 EHR Attestations Now Available

Run Date: 01/16/2014 – 04/30/2014

PV Types: 01- Hospital
31- Physicians
52- State Employed Physicians
09- Advance Practice Nurse
27- Dentist
10– Mid-level Practitioners

 


SoonerCare is now accepting Stage 2 attestations. CMS published a final rule that specifies the Stage 2 criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet in order to continue to participate in the Medicaid Electronic Health Record (EHR) Incentive Programs. If you have not participated in the Medicaid EHR Incentive Programs previously, or if you have never achieved meaningful use under the Stage 1 criteria, please visit www.okhca.org/ehr-incentive or contact us at 405-522-7EHR for more information about how to take part in the program.

1/16/2014 BH Portal Info/Required Security Enhancements

Title: BH Portal Info/Required Security Enhancements

Run Date: 01/16/2014 – 03/01/2014

PV Type: 08, 11, 53 Spc: 110, 111, 112, 115, 121, 193, 585, 535, 536

The provider portal will go live on January 24, 2014, our legal team as well as 45 CFR § 164.304, 164.306 and 164.312 of the Federal Health Insurance Portability and Accountability Act (HIPPA) requires security enhancements that will require all providers and submitters to manually log in and verify certain attributes to upload and download files. Some software on the market had created a script for auto populating security data to upload and download, this practice will no longer be allowed and was never approved by OHCA.  In fact, OHCA advises that for your protection and ours, that you use each of the security functions to insure that PHI and your billing files are kept as secure as possible.

1/15/2014 Webinars: New Portal Training

Title: Webinars: New Portal Training

Run Dates: 01/15/2014 – 02/01/2014

PV Types: All

OHCA and HP Enterprise Services are excited to announce Webinar training sessions. Webinars will address topics for certain provider types that are relevant and timely for you and your staff. These trainings will be hosted by HPES through HP Virtual Rooms and will last approximately one hour.

Register now for these great interactive sessions! The 1500 and UB04 classes will be your last opportunity for training, before the new site goes live!

Classes offered: 

Thursday, January 16 - 2:30 p.m. – 1500 Professional Claim - New Portal (1/16/14)  - Click To Register 

Recommended Audience: All SoonerCare providers, their staff, and billing entities that bill on a 1500 professional claim form.

Description: This class will introduce the new SoonerCare provider portal to providers and entities who, currently, submit 1500 professional claims to the Oklahoma Health Care Authority. This class will cover new and enhanced processes for claim submission, viewing electronic remits, payment history and many additional features.

Thursday, January 23 - 2:30 p.m. – UB-04 Institutional - New Portal (1/23/14)  - Click To Register 

Recommended Audience: This is recommended to all SoonerCare providers, their staff, and billing entities that bill on a UB-04 claim form.

Description: This class will introduce the new SoonerCare provider portal to providers and entities who, currently, submit UB-04 claims to the Oklahoma Health Care Authority. This class will cover new and enhanced processes for institutional UB-04claim submission, and many additional features.

Thursday, January 30 - 2:30 p.m. – Referral - New Portal (1/30/14)  - Click To Register  

Recommended Audience: All SoonerCare Choice MH providers are strongly encouraged to attend as well as specialty providers whose services require a SoonerCare referral.

Description: This class will introduce providers to the new required electronic referral process within the new SoonerCare provider portal. It will cover how Medical Home (MH) providers will initiate specialty referrals and how specialty providers will receive these referrals. Medical Home providers are strongly encouraged to attend this class as this process replaces the paper referral (SC-10) process beginning this winter.

1/9/2014 New 1500 Claim Form Submissions

Title:  New 1500 Claim Form Submissions

Run Date: 01/09/2014 – 02/24/2014

PV Types: All

OHCA is returning many 1500 [paper] Claim Forms to providers. The [new] 1500 Claim Forms are being printed/submitted with the [old] 1500 Form locators information; therefore, the information does not line up and cannot be processed.

Please ensure that all information is printed in the correct areas of the new 1500 Claim Form (02-12) to allow successful processing.

1/6/2014 Exemption for Waiver Programs for Ordering/
Referring Provider NPI Requirement

Title: Exemption for Waiver Programs for Ordering/Referring Provider NPI Requirement

Run Dates: 01/07/2014 – 01/31/2014

PV Types:  250 – DME/Medical Supply Dealers

Unfortunately, OHCA systems have not been updated to agree with the exemption for Ordering/Referring NPI Requirement as of January 6, 2014 previously reported by OHCA and Waiver Advantage.

If your claim has “SUSPENDED” as the denial description; no further action is required by the provider.  OHCA will reprocess claims in this category once the system fix is implemented.

If your denial is anything other than “SUSPENDED”; it will be necessary for you to reprocess the claim after you are notified of the system fix.

OHCA systems staff is working to correct this system edit and you will be notified as soon as it is implemented.

12/30/2013 REMINDER: New Paper 1500 Claim Forms

Title: REMINDER: New Paper 1500 Claim Forms

Run Dates: 12/20/2013 – 03/31/2014

PV Types: All

OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.

12/11/2013 TDaP Guidelines for Pregnant Women

Title: TDaP Guidelines for Pregnant Women

Run Date: 12/11/2013 -01/26/2014

PV Types: All

Recently, the Advisory Committee on Immunization Practices (ACIP) updated the guidelines for TDaP in pregnant women. The revised ACIP guidelines recommend that health care personnel administer a dose of TDaP during each pregnancy, irrespective of the patient’s prior history of receiving TDaP. To maximize the maternal antibody response and passive antibody transfer and levels in the newborn, optimal timing for TDaP administration is between 27 weeks and 36 weeks of gestation, although TDaP may be given at any time during pregnancy. The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice supports these revised recommendations.

SoonerCare covers the TDaP vaccine through a member’s medical home or obstetrician’s office. The TDaP vaccine is also covered for SoonerCare members 19 years of age and older through the pharmacy benefit. A member can receive the vaccine at the health department as well.

12/5/2013 Webinar: Electronic Referrals (New Provider Portal)

Title: Webinar: Electronic Referrals (New Provider Portal)

Run Dates:  12/05/2013 – 12/13/2013

PV Types:   All

HPES and OHCA will be conducting an Electronic Referrals (New Provider Portal) webinar on Dec 12th at 2:30pm.
This webinar will introduce providers to the new required electronic referral process within the new SoonerCare provider portal. It will cover how Medical Home (MH) providers will initiate specialty referrals and how specialty providers will receive these referrals. Medical Home providers are strongly encouraged to attend this class as this process replaces the paper referral (SC-10) process beginning this winter. (This class will be limited to the first 150 registrants)

Classes offered: 

Thursday, December 12 - 2:30 p.m. – Electronic Referrals (New Provider Portal) - Click To Register
Recommended Audience: All SoonerCare Choice MH providers are strongly encouraged to attend as well as specialty providers whose services require a SoonerCare referral.

12/5/2013 Insure Oklahoma CPAP Humidifier (E0562) Change

Effective January 1, 2014, Insure Oklahoma will allow only rental of the E0562 - Humidifier, heated, used with positive airway pressure device. 

The prior authorization should be processed using the following guideline:

Submit PA for 3 months as rental – use LL modifier

Submit PA for convert to Purchase – do not use LL modifier (9 x $19.05=
$171.45)

Submit claim for exact amount - $171.45

CPAP’s and Humidifiers are eligible for convert to purchase at month 4 only – the purchase option does not apply to BIPAP’s.

Future prior authorizations will not be approved for purchase – only rental. 
If you have any questions, contact Stan Ruffner, DME Director at 405.522.7924.

12/2/2013 Changes in Speech Evaluation Codes

Title: Changes in Speech Evaluation Codes

Run Date: 12/02/2013  - 01/17/2014

PV Type: Speech/Hearing Therapist (173); Speech Hearing Clinic (182)

Effective January 1, 2014, CPT code 92506 (speech – language evaluation) is being replaced by new, more specific codes. Please refer to the CPT manual for the proper codes for utilization. The last date of service for CPT code 92506 claims will be December 31, 2013.  Because of these changes, authorizations for CPT code 92506 will end on December 31, 2013. For all speech PA-related questions, please call the OHCA Call Center at 800-522-0114.

11/25/2013 Mandatory Integration of BH Screenings

Title:  Mandatory Integration of BH Screenings

Run Dates: 11/25/2013 – 01/05/2014

PV Types: All

To all Choice providers

You were notified of changes to your Choice contract in October. It involves mandatory integration of Behavioral Health Screenings into your medical home processes for member 5 and above.
Please let us know if you did not receive this notification by e-mailing Provider Services Admins:  ProviderServicesAdmins@okhca.org  . We will send you another copy for your files.

Also be aware that Physician Assistants and Advance Nurse Practitioners who are Choice providers must have their DEA and OBNDD on file as part of the contracting approval process.

Please call the OHCA call center for questions related to contracting at 1-800-522-0114.

11/22/2013 New Paper 1500 Claim Forms

Title: New Paper 1500 Claim Forms

Run Dates: 11/21/2013 – 01/06/2014 And: 12/20/2013 – 03/31/2014

PV Types: All

OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.

11/15/2013 Webinar: PA Submission (New Provider Portal)

Title: Webinar: PA Submission (New Provider Portal)

Run Date: 11/15/2013 – 11/22/2013

PV Types: All

On Thursday November 21st HP will present the Prior Authorization Submission (New Provider Portal) class at 2:30 p.m. These webinars will cover the same information as the Spring/Fall workshops for those that were unable to attend.

All SoonerCare providers and their staff that submit DME and medical prior authorizations are encouraged to attend.(PT, OT, ST, surgical, etc.).This class will guide providers through the new process of submitting medical and DME prior authorizations on the new SoonerCare provider portal. This will be a step-by-step guide on the submission process only- this will not include any discussion over approval criteria or prior authorization policy. This class is not for behavioral health, pharmacy or dental providers. (This class will be limited to the first 125 registrants)

Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar.

November 21st  - 2:30 p.m. – Prior Authorization Submission-New Provider Portal         

 
11/5/2013 WEBINAR – 1500 Professional Claim Submission – New Provider Portal

Title:  WEBINAR – 1500 Professional Claim Submission – New Provider Portal

Run Dates: 11/04/2013 – 12/19/2013

PV Types: All

Due to the overwhelming response and attendance for the 2013 Spring and Fall Workshops that introduced the new provider portal, HP and OHCA will be conducting webinars to assist providers in getting this important training.

On Thursday November 7th, HP will present the 1500-Professional Claim Submission for the New Provider Portal at 2:30 p.m. These webinars will be limited to the first 125 registrants.

Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar.

November 7th, 2:30 p.m. – 1500-Professional Claim Submission-New Provider Portal         

 
10/28/2013 Webinar: Access & Eligibility – New Provider Portal

Title: Webinar: Access & Eligibility – New Provider Portal

Run Date: 10/28/2013 – 11/01/2013

PV Types: All

For all providers

Due to the overwhelming response and attendance for the 2013 Spring and Fall Workshops that introduced the new provider portal, HP and OHCA will be conducting webinars to assist providers in getting this important training.

On Thursday October 31st HP will present the Access and Eligibility class at 2:30 p.m. These webinars will be limited to the first 100 registrants.

Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar.

October 31st  - 2:30 p.m. – Access and Eligibility-New Provider Portal         

 
10/17/2013 Flu Vaccines

Title:  Flu Vaccines
Run Dates: 10/16/2013 – 12/02/2013
PV Types: All

Flu season is here, and as a provider for our SoonerCare members we wanted to remind you of our coverage for this very important preventive service.

Children’s coverage:
The flu vaccine is supplied by the Health Department through the Vaccine for Children’s program. Therefore SoonerCare Choice Primary Care Providers will be reimbursed for the administration only.

All other SoonerCare providers will be reimbursed for the vaccine and the administration.

Adult coverage including Soon to be Sooners members:
OHCA will reimburse for the vaccine and the administration.
If an adult has a valid prescription from a provider they can receive their flu vaccine at a local pharmacy. We pay the cost of the vaccine and the dispensing fee.

SoonerCare Choice Reminder:
Referral requirements apply for services outside the member’s Choice primary care provider, other than prenatal/obstetrical care.

Refer to Dear Provider letter 2013-31 for clarification regarding administration coverage.

10/15/2013 Long Term Care Cost Reports for SFY13

Title: Long Term Care Cost Reports for SFY13

Run Date: 10/14/2013 – 12/01/2013

PV Types: Provider Types 03  Extended Care Facilities

Specialties
30 Nursing Facilities
31 ICF/MR (+6 beds)
34  ICF/MR (-6 beds)
35 Skilled Nursing Facility

Attention: All Long Term Care Facility Providers. 

Long Term Care Cost Reports for SFY13 are due by October 31, 2013. 

According to the approved State Plan, facilities late in filing the long term care cost report may lose the direct care component of their rate which ranges from $14.02 to $29.91 per patient day. Full year Reports are required to be filed on the secure website and partial year reports are required to be filed on the form available on the OKHCA website: www.OKHCA.org 

10/14/2013 Registration for OKC Fall Training

Title:   Registration for OKC Fall Training

Run Date: 10/14/2013 – 10/25/2013

PV Type:  All

Registration for the Oklahoma City Workshop on October 23rd  and 24th  will close today  at 5 pm. If you are registered for this workshop, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site. Most classes in OKC are full, therefore walk-ins will be extremely limited and not guaranteed. If you were unable to register for this workshop, please watch your global messages for additional training opportunities.

10/10/2013 Home: Infusion Therapy-Antibiotic, Antiviral, & Antifungal update

Title:  Home: Infusion Therapy-Antibiotic, Antiviral, & Antifungal update

Run Date: 10/10/2013 – 11/05/2013

PV Types: 250 – DME/Medical Supply Dealers

The Oklahoma Health Care Authority is updating the global of 6/17/13 regarding the authorization process for home infusion therapy for Antibiotic, Antiviral and Antifungal for
 Dual Eligible members only. **Please note #5 is now required effective 10/15/2013. All PA requests received as of this date that do not include a CMN (HCA-29) will be cancelled.
S9494 – Home infusion therapy, antibiotic, antiviral or antifungal therapy; administration services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately, per diem).

Medicare Part D:

Effective July 1, 2013,  providers serving members with Dual Eligibility benefits (Medicare Part D) will be required to submit the following for a Prior Authorization using the S9494 code:
1. HCA-13A Prior Authorization Fax Cover Sheet
2. HCA12-A Prior Authorization Form
3. Prescription detailing the orders, including duration of treatment
4. Medicare D Billing Response showing payment for the drug
5. HCA-29 OHCA Certificate of Medical Necessity External Infusion Pump is required per  
   OHCA Policy (update 10/4/2013)
(***Medical records are NOT REQUIRED to be submitted for Medicare Part D)
OHCA will no longer cover the monthly pump rental (E0781 or E0791) for these medications nor the supplies (A4221 or A4222) starting July 1, 2013.
Medicare Part B: please continue to file with Medicare.
Title XIX: Continue to follow the current process for Prior Authorizations.
For all DME/Medical Prior Authorizations related questions, please contact the Medical Authorization Unit at 1-800-522-0114.

10/4/2013 DMEPOS Provider Contract Renewal Period Open Now

Title: DMEPOS Provider Contract Renewal Period Open Now

Run Date: 10/04/2013 – 11/19/2013

PV Type: 250 – DME/Medical Supply Dealers

DMEPOS CONTRACTS ARE EXPIRING JANUARY 31, 2014.  THE ELECTRONIC PROVIDER ENROLLMENT APPLICATION WILL BE AVAILABLE ON THE SECURE WEBSITE AS EARLY AS 10/7/13.

REMINDER – WHEN SUBMITTING YOUR RENEWAL CONTRACTS, YOU MUST FAX A COPY OF YOUR PROOF OF ACCREDITATION, YOUR MEDICARE EXEMPTION LETTER; OR A LETTER ADDRESSED TO OHCA REQUESTING AN EXEMPTION FROM THE ACCREDITATION REQUIREMENT.  SEE THE EXEMPTION LIST THAT IS POSTED ON THE PUBLIC WEBSITE AT WWW.OKHCA.ORG.

BEGINNING WITH THIS RENEWAL PERIOD, OHCA POLICY REQUIRES THAT DMEPOS PROVIDERS MUST HAVE A PHYSICAL LOCATION IN THE STATE OF OKLAHOMA OR REQUEST AN EXCEPTION TO THIS REQUIREMENT.  PROVIDER CONTRACTS FOR OUT OF STATE DMEPOS PROVIDERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS. THE OHCA HAS DISCRETION AND THE FINAL AUTHORITY TO APPROVE OR DENY ANY PROVIDER CONTRACT.

PLEASE USE THE EMAIL FIELD TO UPDATE YOUR PROVIDER FILE WITH THE EMAIL ADDRESS OF YOUR COMPANIES’ CONTRACT MANAGER

YOU MAY CONTACT STAN RUFFNER AT stan.ruffner@okhca.org if you have specific question about exemptions.  Otherwise, please contact Provider Enrollment at 800.522.0114 Option 5.

9/30/2013 Tulsa & OKC 2013 Fall Training Workshops

Title: Tulsa & OKC 2013 Fall Training Workshops

Run Dates: 09/30/2013 – 10/28/2013

PV Types:  All

Registration for the Tulsa Workshop on October 9th and 10th will close October 2nd at 5:00 pm. The registration for OKC is still open; however, most classes are full. If you are registered for the Tulsa or OKC workshop, please make every effort to attend. These important trainings are relative to all providers who are currently using the SoonerCare Secure Site.

To register, go to: www.okhca.org/register 

For a list of classes and their descriptions, go to: www.okhca.org/classes 

9/24/2013 DSM-V Changes

Title: DSM-V Changes

Run Date: 09/24/2013 – 11/09/2013

PV Types: 11, 53 SPC: 110,111, 112,121,115,535,536,585,586

Dear Behavioral Health Provider:

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released by the American Psychiatric Association (APA) in May 2013. In order to comply with the APA’s request for insurers to implement the new changes by the end of the year, OHCA and the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) plan to accommodate the DSM-5 by 1/1/2014. The only changes that will impact your daily practice are related to the prior authorization process and fields on the CDC. PICIS will still require diagnoses, but there will be five open diagnoses fields instead of splitting between axis 1 and 2. Axis 4 questions will no longer be required, and will not be visible in PICIS. At provider requests, we will leave the Axis 3 diagnosis field to allow providers to still record medical issues with the customer. DSM-5 was created to cross- walk with both ICD-9 and ICD-10, so there should be no implementation issues when ICD-10 is implemented in late 2014.

For inpatient behavioral health providers, the only impact to you will be related to the inpatient clinical templates that are submitted by your utilization review department.  New revised templates will be posted on OHCA’s website by December 01, 2013 for use beginning January 01, 2014.

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

9/17/2013 Registration for Lawton SC Provider Workshop

Title: Registration for Lawton SC Provider Workshop

Run Date: 09/17/2013 – 10/25/2013

PV Type: All

Registration for the Lawton SoonerCare Provider Workshop on September 26th will close Thursday Sept 19th at 5 pm. Classes are filling up quickly, therefore walk-ins will be limited in Lawton and on a first come, first serve basis. (Walk-in registrations are not guaranteed.) The registrations for Tulsa(Oct 9 & 10), and OKC (Oct 23 & 24) are still open; however, many classes are full. If you are registered, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site.

To register, go to: www.okhca.org/register 

For a list of classes and their descriptions, go to: www.okhca.org/classes 

9/17/2013 Webinar

On September 24, 2013, the HP EDI department will be presenting a webinar over the NPI Crosswalk for Oklahoma SoonerCare Electronic Claims. The Webinar was created to provide information on the SoonerCare solution to the NPI crosswalk and to assist providers in resolving their NPI crosswalk claim denials. We will discuss how to crosswalk an NPI number to the appropriate Medicaid billing or rendering legacy provider id number utilizing additional information, such as zip+4, contract code and taxonomy code. The NPI Crosswalk for Medicare Crossover claims will not be discussed in this presentation. (Class is limited to the first 100 registrants)

Target Audience:  SoonerCare Providers, billing agents, clearinghouses and software vendors who are currently uploading claims electronically (NOT submitting claims directly on the SoonerCare secure website) and have a desire to learn more about Oklahoma Medicaid NPI Crosswalk are encouraged to attend this webinar.

September 24, 2013 - 2:30 p.m. – NPI Crosswalk for Electronic Billers 

Click To Register 

9/12/2013 2013 Durant Fall Training

Title: 2013 Durant Fall Training

Run Date: 09/12/2013 – 10/31/2013

PV Types: All

Registration for the Durant SoonerCare Provider Workshop on September 16th will close today at 5:00 pm. Classes are filling up quickly, therefore walk-ins will be limited in Durant and on a first come, first serve basis. (Walk-in registrations are not guaranteed.) The registrations for Lawton, OKC, and Tulsa are still open; however, many classes are full. If you are registered, please make every effort to attend. These are important trainings that are relative to all providers who are currently using the SoonerCare Secure Site.

To register, go to: www.okhca.org/register 

For a list of classes and their descriptions, go to: www.okhca.org/classes 

9/10/2013 Fall 2013 School-Based Training

Title:  Fall 2013 School-Based Training

Run Dates: 09/09/2013 – 10/23/2013

PV Types:  12

SPC:  120

School-Based Training is scheduled for the following dates and times.

  • September 24, 2013 – Oklahoma City (10:00 am to 12:00pm)
  • October 1, 2013 – McAlester (10:00am to 12:00pm)
  • October 08, 2013–  Stillwater (10:00am to 12:00pm)
  • October 22, 2013– Poteau (1:00pm to 3:00pm)

Register for the training through OHCA website at
http://www.okhca.org/schoolbased 

9/9/2013 BOTOX Prior Authorization

Title: BOTOX Prior Authorization

Run Date: 09/09/2013 – 10/23/2013

PV Types: All

As stated in the dear provider letter number 2013-12, Botox requires Prior Authorization through the Pharmacy Prior Authorization Unit. Please use PHARM-24 form to submit your request for Botox.

9/6/2013 Clarification of Recent PA Web Alert

Title:  Clarification of Recent PA Web Alert

Run Date: 09/04/2013 – 10/19/2013

PV Types: 27 – Dentist Spc:  086 – Dental Clinic

Dear Dental Providers:

Please be advised that the September 3rd, 2013 web alert regarding Prior Authorizations refers to MEDICAL Prior Authorizations only, not DENTAL.

Thank you.

8/13/2013 Heparin Lock Flush

Title: Heparin Lock Flush

Run Date: 08/08/2013 – 09/23/2013

PV Types: All
 
Effective 7/1/13, OHCA will no longer allow reimbursement for J1642, heparin lock flush.  CMS considers this service integral to the procedures billed when a member has a port for IV access.  Heparin flush is not separately billable.
8/8/2013
 
Coverage of Carrier Screening

Title:  Coverage of Carrier Screening

Run Dates: 08/09/2013 – 09/15/2013

PV Types: All

This message is regarding genetic tests used to determine carrier status for cystic fibrosis (CF), Fragile X, and spinal muscular atrophy (SMA). 

Consistent with the recommendations set forth by ACMG and ACOG, OHCA considers CF carrier screening using the common mutation panel (CPT code 81220) to be medically necessary once in a lifetime for women of reproductive age and the partners of those that test positive.  Expanded mutation panels beyond those recommended by ACMG/ACOG are not considered medically necessary and will be reimbursed at a rate that is based on the common variant panel alone.

OHCA does not consider other carrier screening in the general population to be medically necessary.  In particular, carrier screening for Fragile X (CPT code 81243) and SMA (CPT code 81401) are not considered medically necessary in the absence of a family history suggestive of those conditions.  This is consistent with the ACOG and ACMG recommendations for Fragile X carrier screening and the ACOG recommendations for SMA carrier screening.

Please feel free to contact Alison Martinez, Ph.D. at alison.martinez@okhca.org with any questions.

8/8/2013 Nutritional Products Pricing “BY REPORT”

Title:  Nutritional Products Pricing “BY REPORT” 

Run Dates: 08/08/2013 – 11/30/2013

PV Types: 250 – DME/Medical Supply Dealers 

Effective for prior authorizations submitted after October 1, 2013 for selected enteral nutritional products; providers may use the prices listed on the worksheet posted on the DME website located at www.okhca.org. The worksheet is located under the PRICING tab.

For prior authorizations submitted after October 1, 2013; invoices will not be required when the product is listed on this report.  The PA will be priced using this report.  If the product in question is not on this list, providers must submit an invoice showing cost with the PA request.

The report will be updated quarterly – if you have an addition or correction, send to stan.ruffner@okhca.org with the product description, NDC, Manufacturer Product Code and changes will be made if deemed appropriate.

8/5/2013 Webinar re: Speech Therapy Prior Authorization Requests

Title: Webinar re: Speech Therapy Prior Authorization Requests

Run Dates: 08/01/2013 – 08/23/2013

PV Types: All

The OHCA Medical Authorization Unit will be presenting a webinar for Speech Therapy Prior Authorization Requests. This webinar will review the Prior Authorization process for Speech Therapy, including required documentation and clarification of the 90-day timeframe. The recommended audience would be any SoonerCare provider, including Speech Therapy Providers, needing an overview of the PA submission process for Speech Therapy. This webinar will be limited to the first 100 registrants. We look forward to seeing you.

August 22, 2013 @ 2:30 p.m. – OHCA Speech Therapy Prior Authorizations.
7/29/2013 Orthotics Utilization Changes

Title: Orthotics Utilization Changes

Run Dates: 07/29/2013 – 12/31/2013

PV Types: 250 – DME/Medical Supply Dealers

Due to efforts to insure medical necessity is documented for use of Orthotic devices, OHCA has place reasonable limits on the Orthotic HCPCS codes (L0100-L4999) effective July 1, 2013.  You can access the utilization limits on the public website at www. Okhca.org under the Provider Type – DME tab.

Policy 317:30-5-211.13  Prosthetic & Orthotic devices indicates that …There is no coverage of orthotics for adults.

All items in this classification are eligible for a PA override if the utilization limit has been reached in the past 12 months – an HCA 12A indicating the medical necessity for the additional product along with any growth measurements that will support the need is necessary for the MAU staff to review for appropriateness.

This change will allow for medically necessary Orthotic products to be replaced prior to the one year limit if prior authorized.  Contact Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org if you have any questions about this change.
7/25/2013 Outpatient Behavioral Health Svs Fee Schedules

Title: Outpatient Behavioral Health Svs Fee Schedules

Run Date:    07/24/2013 – 09/08/2013

PV Types:    53  –  Licensed Behavioral Health Practitioner (LBHP) Spc:    112 –  Psychologist 535 -  LBHP

Dear Behavioral Health Provider:

Effective July 1, 2013 outpatient behavioral health services fee schedules for private Psychologists and Licensed Behavioral Health Professionals (LBHPs) were revised to reflect annual updates to the Medicare fee schedule. The current fee schedules can be located by visiting www.okhca.org/behavioral-health. These rates are effective for claims with dates of service on and after July 1, 2013.
7/23/2013 Audiology Students

Title: Audiology Students

Run Date: 07/23/2013 – 09/05/2013

PV Type: 20 Audiologist SPC 200 Audiologist

The purpose of this announcement is to give additional guidance on services provided by audiology students. Per OAC 317:30-5-675 SoonerCare eligible speech and hearing providers must be either state licensed speech/language pathologist or state licensed audiologist.

Audiology students are not qualified SoonerCare providers, therefore services rendered by a student will not be reimbursed. However, an audiology student may participate in the rendering of the service as long as the qualified, licensed audiologist is:

• Present and in the same room, one-to-one with the student for the entire audiology session; and
• Guiding the delivery of services; and
• Making the skilled judgment; and
• Is not engaged in treating another patient or performing another task at the same time.

The qualified practitioner is responsible for all services and all documentation. Students may assist in the completion of the documentation and sign the documentation. However, the qualified practitioner must co-sign the documentation, which includes a signed personal attestation. In this attestation, the practitioner must attest to his/her presence and participation during the services, and the completion and accuracy of the audiology assessment, treatment plan, and services rendered.

7/23/2013 New Fee Schedule

Title:  New Fee Schedule

Run Date: 07/23/2013 - 09/05/2013

PV TYPES: All

Remember that we update our fee schedule every July. The new fee schedule is on the web.

Dates of service prior to July 1, 2013 are paid at last year’s rate and dates of service after July 1, 2013 are paid at the new rate.

7/23/2013 Medicare Non-Covered Transportation Svs

Title: Medicare Non-Covered Transportation Svs

Run Date: 07/23/2013 – 08/31/2013

PV Types:  26 – Transportation
     073 – Non ER
     260 – Ambulance
     261 – Air Ambulance
     262 – Bus
     263 – Taxi

When transportation services are not covered by Medicare and the destination is to the ER, an appeal from Medicare is no longer required. Send the completed HCA-17 form, along with  the claim form and the Medicare EOB  showing the denial reason to: Attn: Provider Services Oklahoma Health Care Authority PO Box 18506, Oklahoma City, OK 73154.

07/22/2013 SC-10 – SoonerCare Referral Form Clarification for DMEPOS Items

Title:  SC-10 – SoonerCare Referral Form Clarification for DMEPOS Items

Run Date: 07/17/2013 – 08/05/2013

PV Types: 25 – DME Providers

Dear DME Provider:

This message clarifies that the use of the SC-10 SoonerCare Referral Form is NOT required for claims for DMEPOS Items. This applies to all DMEPOS claims.

Please contact Stan Ruffner, DME Director at stan.ruffner@okhca.org  with any questions.

07/15/2013   ACA Primary Care Enhanced Rate Adjustment 

Title:   ACA Primary Care Enhanced Rate Adjustment 

PV Type:      

09 – Advance Practice Nurse 

31 – Physician 

10 – Mid-level Practitioner 

52 – State Employed Physicians 

SPC:  564 – Eligible Primary Care Provider 

093 – Advanced Registered Nurse Pract 

The first quarter Jan–Mar claims for ACA qualified primary care providers as well as all the vaccine administration claims for kids will be paid on your 7/24 remits.  The second quarter Apr–Jun claims for ACA qualified primary care providers will be paid on your 7/31 remits.  The EOB code for the enhanced payment is 8147 and the EOB code for vaccine administration is 8155.  

7/12/2013 Sign-Up for Web Alerts

Title: Sign-Up for Web Alerts

Run Dates: 07/11/2013 – 08/25/2013

PV Types:  All

To make sure you get updates related to the SoonerCare program please sign up for web alerts on our public website. Especially important is the Provider Letter page. Anyone can sign up for web alerts so multiple members of your staff can receive the updated information.

In addition to that method of communication, all of our provider letters are sent electronically. Please log onto the secure site and update your e-mail on your contract file. This will provide another way to have up to date information about SoonerCare. 

www.okhca.org/webalerts 

7/2/2013 School-Based Billing Rates

Title: School-Based Billing Rates

Run Date: 07/02/2013 – 08/31/2013

PV Types: 12 / 120 – School-Based Providers

Effective 7/1/2013 School-Based billing rates have changed.

Review the updated fee-schedule rates on the OHCA website at
http://www.okhca.org/providers.aspx?id=566 

6/25/2013 DEN-3, Dental Provider Change Form
 

Title: DEN-3, Dental Provider Change Form

Run Date: 06/25/2013 – 08/14/2013

PV Types: 27 – Dentist

Spc:  086 – Dental Clinic

Dental providers: 

Effective immediately, OHCA has implemented a revised “DEN-3, Dental Provider Change Form”.  The form is located on the public website in the “Forms” section. Please replace any old forms you may have on hand.  Please note a parent/guardian signature & contact phone is now required for all change of provider requests/transfers.  The new rendering dentist will also need to sign the form. This must be completed and faxed to OHCA prior to services rendered.  Thank you for your continued support to SoonerCare members, and your cooperation in this matter.

6/17/2013 Home Infusion Therapy – Antibiotic, Antiviral and Antifungal

Title: Home Infusion Therapy – Antibiotic, Antiviral and Antifungal

Run Date:  6/17/2013 – 7/31/2013

PV Types:  DME/Medical Supply Dealers 250 

The Oklahoma Health Care Authority has revised the authorization process for home infusion therapy for Antibiotic, Antiviral and Antifungal for Dual Eligible members only.

S9494 – Home infusion therapy, antibiotic, antiviral or antifungal therapy; administration services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately, per diem).

Medicare Part D:
Effective July 1, 2013,  members with Dual Eligibility benefits (Medicare Part D) will be required to submit the following for a Prior Authorization using the S9494 code:
1. HCA-13A Prior Authorization Fax Cover Sheet
2. HCA12-A Prior Authorization Form
3. Prescription detailing the orders, including duration of treatment
4 Medicare D Billing Response showing payment for the drug 

(***Medical records are NOT REQUIRED to be submitted for Medicare Part D)
OHCA will no longer cover the monthly pump rental (E0781 or E0791) for these medications nor the supplies (A4221 or A4222) starting July 1, 2013.

Medicare Part B: please continue to file with Medicare.

Title XIX: Continue to follow the current process for Prior Authorizations.

For all DME/Medical Prior Authorizations related questions, please contact the Medical Authorization Unit at 1-800-522-0114.

6/11/2013 Additional Guidance

Title: Additional Guidance

Re: Provider Letter OHCA 2013-05

Run Date: 06/12/2013 – 07/27/2013

PV Types: 173 – Speech/Hearing Therapist 182 – Speech/Hearing Clinic

The purpose of this announcement is to give additional guidance on provider letter OHCA 2013-05, dated February 14, 2013 and OHCA policy regarding the prior authorization (PA) process for Speech and Language Pathology services. OHCA policy OAC 317-30-5-676 states “All therapy services, including the initial evaluation, must be prior authorized. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. The prescribing or referring provider must be able to provide, if requested, clinical documentation from the member's medical record that supports the medical necessity for the evaluation and referral.” Other licensed practitioner of the healing arts refers to PAs, ARNPs or CNSs. The intent of this policy language is to assure that all referrals or orders for therapy services are written and signed by the member's treating provider (i.e. Physician, PA, ARNP or CNS). We are informing SLP providers that the referring or ordering provider, whether a physician, PA, ARNP or CNS, must be actively treating the member for which the services are being requested.

To insure the referral or order is generated from a provider actively treating the member and that the services are medically necessary, effective immediately any new PA request submitted to the OHCA Medical Authorization Unit will only be considered if submitted with clinical documentation from the member’s treating provider, which supports the medical necessity for the services requested. Any PA request submitted prior to this date will not require this treating provider documentation in order to be considered, however OHCA may still ask for it if necessary to support medical necessity.
 
Additionally, referrals or orders will be considered valid for a maximum of 90 days, i.e. the PA request must be submitted with a signed referral or order no older than 90 days.

If you have additional questions please contact the Medical Authorization Unit at 1-800-522-0114.

6/4/2013 Provider Portal – “Go Live” Delay
 

Title:  Provider Portal – “Go Live” Delay

Run Date: 06/04/2013 – 07/19/2013

PV Types: All

To allow for additional testing, enhancements and training of providers for the new provider portal, OHCA will delay the “Go Live” date until the Fall of 2013.

Providers should continue to watch their global messages and the OHCA training page for updates and training opportunities.

5/29/2013 Registration for May 30th Webinar

Title: Registration for May 30th Webinar

PV Types: All

Run Date: 05/29/2013 – 05/30/2013

Due to the overwhelming response and attendance for the 2013 Spring Workshops that introduced the new provider portal, HP and OHCA will be conducting webinars to assist providers in getting this important training. We understand that many of these classes filled up quickly and some providers were unable to attend the onsite trainings.

Therefore, on May 30th we will hold our first webinar for these popular classes. The MAU (Prior Authorization Submission) Presentation will be held at 2:30 p.m. These webinars will be limited to the first 100 registrants.

Note: For multiple users per provider office, please incorporate a conference room or work station set up (using one registrant and conference line) this will increase the efficacy of our training and accommodate more providers per webinar.

May 30  - 2:30 p.m. – MAU (Prior Authorization Submission)         

 
5/28/2013 FFY13 3rd Quarter Disproportionate Share (DSH)

Title: FFY13 3rd Quarter Disproportionate Share (DSH) Payment

Run Date: 05/22/2013 – 07/07/2013

PV Types: 01 - Hospitals

The FFY13 third quarter Disproportionate Share Payment (DSH) scheduled for the June 5, 2013 remit will be paid on the June 12, 2013 remit.

5/22/2013 FFY13 3rd Quarter Disproportionate Share (DSH) Payment

Title: FFY13 3rd Quarter Disproportionate Share (DSH) Payment

Run Date: 05/22/2013 – 07/07/2013

PV Types: All

The FFY13 third quarter Disproportionate Share Payment (DSH) scheduled for the June 5, 2013 remit will be paid on the June 12, 2013 remit.

5/13/2012 Registration for 2013 OKC Spring Workshop

Title: Registration for 2013 OKC Spring Workshop

PV Types: All Providers

Run Date: 05/13/2013 – 05/21/2013

The Tulsa Workshop registration on May 22nd and 23rd is now closed and all classes are full. As a reminder, you must be pre-registered to attend and WALK-IN REGISTRATION WILL NOT BE AVAILABLE.

For more information and training opportunities about the new provider portal, please continue to watch your global messages and the OHCA Provider Training page. 

5/8/2013 Registration for 2013 Tulsa Spring Workshop

Title: Registration for 2013 Tulsa Spring Workshop

PV Types: All Providers

Run Date: 05/08/2013 – 05/21/2013

Limited classes remain for the Tulsa Workshop on May 22nd and 23rd; however, registration is still open and will close Friday May 10th at 5:00pm. Each attendee must have their own registration and please thoroughly read the class descriptions and recommended audiences before choosing your classes.

Class Descriptions: http://www.okhca.org/Classes Registration Tool: http://www.okhca.org/Register 

To make ANY changes to your registration, please call 405.416.6730 or email HPokxixTraining@hp.com<mailto:HPokxixTraining@hp.com>.

For more information and training opportunities about the new provider portal, please continue to watch your global messages and the OHCA Provider Training page.

4/23/2013 SoonerCare Dental 101 Webinar

TITLE: SoonerCare Dental 101 Webinar

Run Date: 04/24/2013

PV Types: All

PLEASE JOIN US FOR THE SOONERCARE DENTAL 101 WEBINAR TOMORROW APRIL 25TH!

OHCA and HPES will host a webinar/conference call for all dental providers. This webinar will focus on submission of current dental prior authorizations and general dental policy. This webinar will not cover the new enhanced provider portal. The recommended audience would be all SoonerCare Dental Providers.
The webinar will take place via online virtual room and conference call on April 25th at 2:30.

Please register to take part in this great webinar before 5pm on Wed 4/24/13.

Register today!
Information is available at:
http://okhca.org/providers.aspx?id=110&parts=7557_7559 

Registration is available at:
http://okhca.org/xwebinars.aspx 

4/22/2013 Registration for 2013 OKC Spring Workshop

Title: Registration for 2013 OKC Spring Workshop

PV Types: All Providers

Run Date: 04/22/2013 – 05/08/2013

Registration for the Oklahoma City Spring Workshop on May 8th and 9th will close April 22nd at 5 p.m. The OKC workshop is full and we will not be able to take walk-in registration. Some classes remain open for the Tulsa Workshop on May 22nd and 23rd.  Each attendee must have their own registration and please thoroughly read the class descriptions and recommended audiences before choosing your classes. Register today!

Information and registration is available at:

Class Descriptions: http://www.okhca.org/Classes 
Registration Tool: http://www.okhca.org/Register 

To make ANY changes to your registration, please call 405.416.6730 or email HPokxixTraining@hp.com.

4/19/2013 NB-1 The NB-1 application is fully functional. If you experience any issues please call 1-800-522-0114 option 2 option 1.
4/16/2013 To all hospital facilities

To all hospital facilities

In follow up to our global message related to enrollment system upgrade, 4/12-4/15-2013. The NB-1 application continues to be unavailable. We are making necessary changes to restore this application. We will send an update when the system is ready to go. Remember all babies will be added to the eligibility system with an effective date of their date of birth.
Thank you for your patience.

4/11/2013 SoonerCare Dental Webinar

Title: SoonerCare Dental Webinar

Run Date: 04/10/2013 – 04/24/2013

PV Types: 27 – Dentist

The OHCA Dental unit will be offering a SoonerCare Dental 101 class on April 25, 2013 at 2:30pm. All SoonerCare Dental providers are encouraged to attend. The class will focus on submission of dental prior authorizations and general dental policy.

To Register please visit:  http://okhca.org/xwebinars.aspx 

4/10/2013 Enrollment Software Improvements

Title: Enrollment Software Improvements

Run Date: 04/01/2013 – 05/15/2013

PV Type:  01 – Hospitals

Beginning at 12:01 am on April 12, 2013 the enrollment system will be down. We are enhancing the enrollment software to improve the member and provider experience. This down time will last until 12:00 midnight April 15, 2013. During this time providers will not be able to enroll newborns or notify OHCA of admissions of potentially eligible members (NODOS).

All babies born during this time will be enrolled beginning  April 16, 2013 and be eligible as of the child’s date of birth. NODOS’ needed during this time will be backdated. You must notify us of the need for a NODOS for April 12, 2013 through April 15, 2013 before the COB on April 18, 2013.

4/9/2013 Registration for 2013 Enid Spring Workshop

Title: Registration for 2013 Enid Spring Workshop

Run Date: 04/09/2013 – 04/18/2013

PV Type:  All

Registration for the April 18, 2013 Spring Workshop for Enid will close on Thursday, April 11th at 5 p.m. Registration for locations in OKC and Tulsa are still available. This workshop is going to be very large in numbers and many classes are already closed, so please make sure you are only registered for the classes that pertain to you and will attend. We will not be able to allow walk-in registration for these workshops. Each attendee must have their own registration and please thoroughly read the class descriptions and recommended audiences before choosing your classes. Register today!

Information and registration is available at:
Class Descriptions: http://www.okhca.org/Classes 
Registration Tool: http://www.okhca.org/Register
To make ANY changes to your registration, please call 405.416.6730 or email HPokxixTraining@hp.com.

4/8/2013
 
Follow-up to Provider Letter 2013-03 re: Enhanced Payments

Title: Follow-up to Provider Letter 2013-03 re: Enhanced Payments

Run Date: 04/08/2013 – 05/23/2013

PV Types: 31 – Physicians
52 – State Employed Physicians
090 – Nurse Practitioner 
100 – Physician’s Assistant

To all Primary Care Providers

As mentioned in provider letter 2013-03 primary care providers can qualify for enhanced payments for E&M and Vaccine Administration services beginning January 1, 2013. We know many physicians have not completed the necessary documents to qualify. (Nurse practitioners and physician assistants should contact their supervising physicians to see if they qualify.) We want to make sure you get the enhanced payment for the services you provide. Our first reconciliation payment has been delayed until next month to allow more providers time to attest. PLEASE review the information on our public website, review the dear provider letter and if you have any additional questions please call 1-800-522-0114 option 5.

4/8/2013 Cell-Free Fetal DNA Testing aka Non-Invasive Prenatal Testing (NIPD)

Title:  Cell-Free Fetal DNA Testing aka Non-Invasive Prenatal Testing (NIPD)

Run Date: 04/08/2013 – 05/24/2013

PV Types: All

This message is regarding services for cell-free fetal DNA testing billed to members served by the Oklahoma Health Care Authority (OHCA). These tests may be marketed under trade names including MaterniT21 (Sequenom),Harmony (LabCorp/Ariosa), Panorama (Bio-Reference Labs/Quest/Natera), or Verifi (Verinata).  The list prices for these tests range from ~$800 to ~$2,700.

While we recognize the value of genetic testing when such testing has a direct impact on clinical outcomes and is fully evaluated, accepted, and incorporated into evidence-based guidelines, we have determined that the aforementioned tests do not meet this threshold.  Therefore, these tests are not compensable services, and members will be responsible for any charges resulting from cell-free fetal DNA testing services.

Please feel free to contact Alison Martinez, Ph.D. at alison.martinez@okhca.org with any questions.

4/3/2013 Registration for 2013 Durant Spring Workshop

Title: Registration for 2013 Durant Spring Workshop

Run Date: 04/03/2013 – 04/04/2013

PV Types: All

Registration for the April 11 2013 Spring Workshop for Durant will close today, April 3rd at 5 p.m. Registration for locations in Enid, OKC and Tulsa are still available. This workshop is going to be very large in numbers and many classes are already closed, so please make sure you are only registered for the classes that pertain to you. We will not be able to allow walk-in registration for these workshops. Each attendee must have their own registration and please thoroughly read the class descriptions and recommended audiences before choosing your classes. Register today!

Information and registration is available at: 

Class Descriptions: http://www.okhca.org/Classes 
Registration Tool: http://www.okhca.org/Register 

To make ANY changes to your registration, please call 405.416.6730 or email HPokxixTraining@hp.com.

4/1/2013 2013 EHR Incentive Attestations Now Open

Title: 2013 EHR Incentive Attestations Now Open

Run Date: 04/01/2013 – 05/15/2013

PV Types: 01- Hospital

31- Physicians
52- State Employed Physicians
09- Advance Practice Nurse
27- Dentist

OHCA is now accepting EHR attestations for the 2013 EHR participation year. For a synopsis of the changes please go to http://www.okhca.org/2013-EHR-Changes. If you have additional questions, please contact Melissa Clampitt at 405-522-7567.

4/1/2013 Potential Denials for K0001 for March 2013

Title: Potential Denials for K0001 for March 2013

Run Dates: 3/29/13 thru 6/30/13

PV Types: 250 – DME/Medical Supply Dealers

Due to the OHCA system setting, there is a probability that you have received denials for March 2013 claims for K0001 rental episodes.

The OHCA system was set to require 30 calendar days between claims – see example:

Date of Service  - February 10, 2013   (18 days in February)

Date of Service – March 13, 2013 (12 days in February – 30 days have elapsed – use a date after March 13, 2013 and prior to March 31, 2013 for the March date of service.

The OHCA system has been corrected to allow one claim per calendar month beginning in April 1, 2013 for the K0001 code.  You may bill the April date of service using your normal billing date.

Contact Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org for additional clarification.  We regret the situation.

3/26/2013 2013 EHR Incentive Program Changes

2013 EHR Incentive Program Changes

Title: 2013 EHR Incentive Program Changes

Run Date: 03/26/2013 – 05/05/2013

PV Types: 01- Hospital
31- Physicians
52- State Employed Physicians
09- Advance Practice Nurse
27- Dentist

OHCA will begin accepting EHR attestations Monday, April 1st, for the 2013 EHR participation year. For a synopsis of the changes please go to http://www.okhca.org/2013-EHR-Changes. If you have additional questions, please contact Melissa Clampitt at 405-522-7567.

3/20/2013 New SoonerCare Provider Portal/2013 Spring
Provider Training Workshop
 

TITLE: New SoonerCare Provider Portal/2013 Spring Provider Training Workshop

Run Date: 03/20/2012 – 05/15/2013

PV Types: All

THE NEW SOONERCARE PROVIDER PORTAL WILL BE INTRODUCED AT THE 2013 SPRING PROVIDER TRAINING WORKSHOP!

ALL PROVIDERS are encouraged to attend the Spring 2013 SoonerCare Provider Training Workshops hosted by the Oklahoma Health Care Authority (OHCA) and HP Enterprise Services. Workshops will include training on the new SoonerCare Provider Portal (formally the Secure Site) as well as Behavioral Health training. These workshops will be held in 4 locations, beginning April 11th.

Register today! Information and registration is available at: 

Class Descriptions: http://www.okhca.org/Classes 
Registration Tool: http://www.okhca.org/Register 

Durant, OK will be the first stop on April 11 followed by: Enid, April 18; Oklahoma City, May 8–9; and, conclude in Tulsa, May 22–23.

3/18/2013 Reminder: Change to Call Center Operations

Title: Reminder: Change to Call Center Operations
Run Date: 03/15/2013 – 05/01/2013
PV Types: All

Beginning December 21, 2012 OHCA made changes to its call center operations. For faster service, please use OHCA’s SoonerCare Secure web site or Member Eligibility Verification Voice Response System for all claims status and eligibility inquiries. Thank you for your cooperation.

Please make sure all parties involved with Claims submission and eligibility verification have access to your secure site and EVR information.

Please also reference OHCA 2013-02 Provider Letter RE: New OHCA Call Center Vendor & Call Center Questions for further clarification and/or instruction.

These changes are effective April 1, 2013.

This transition does not affect the Pharmacy Help Desk calls.

3/14/2013 REMINDER:
New FAX# for SC-13 Form, Provider Change Request

TITLE: REMINDER:

New FAX# for SC-13 Form, Provider Change Request

Run Date: 03/14/2013 – 05/01/2013

PV Types: All

To:   All Medical Home Providers

Due to changes in the OHCA Call Center the SC-13 form, Provider Change Request form, has been updated to reflect a new fax number.  The new fax number is now (405) 917-7374. 

The new SC-13 form is accessible on the OHCA public website, www.okhca.org, under “Forms”. Medical Home providers need to replace any copies of the old SC-13 form and replace it with the new form (revision date March 1, 2013) beginning February 28, 2013. 

SC-13 forms faxed to the obsolete FAX#, (405) 782-8780, will not be processed after February 27, 2013.

3/4/2013 School-Based Training Dates

Title: School-Based Training Dates

Run Dates: 03/01/2013 – 04/05/2013

PV Types:  12 – School Corporation
     Spc:  120- School Corporation


School-Based Training is scheduled for the following dates and times.

March 14, 2013 – McAlester (10:00 am to 12:00pm)
March 26, 2013 – Stillwater (10:00am to 12:00pm)
March 28, 2013– Oklahoma City (10:00am to 12:00pm)
April 3, 2013– Poteau (1:00pm to 3:00pm)

Register for the training through OHCA website at: http://www.okhca.org/schoolbased 

2/28/2013 Webinar Training – Medical Authorizations - General Overview

Title: Webinar Training – Medical Authorizations - General Overview

Run Date: 02/27/2013 – 03/29/2013

PV Types: All

SoonerCare Webinar Training

OHCA and HP Enterprise Services are excited to announce a medical authorization webinar training. This is a general overview of the medical PA (does not include Dental, BH or Pharmacy) submission process. The recommended audience would be any SoonerCare provider needing a general overview of the PA submission process.

March 28, 2013  - 2:30 p.m. – PA Submission: General Overview

To register please visit:  http://okhca.org/xwebinars.aspx 

2/27/2013 OHCA 2013-05 Provider Letter

Title: Clarifications – OHCA 2013-05 Provider Letter

Run Date: 02/27/2013-04/15/2013

PV Types: 173 – Speech/Hearing Therapist 182 – Speech/Hearing Clinic

Global to clarify Provider Letter OHCA 2013-05 regarding referrals for speech therapy evaluations and speech therapy sessions: 

1. The referral document must include the type(s) of therapy services requested (e.g., “speech evaluation and treatment”, “speech-language evaluation”, etc.).
2. Medical diagnosis (if available) may be included on the referral document; treatment diagnosis should be included in evaluation report/treatment plan.
3. Frequency & duration recommendations may be contained within the evaluation report/treatment plan documentation. 
4. The referral/script MUST identify the specific service(s) ordered (for example, “speech services” is not sufficient.
5. A signed referral and/or prescription must be obtained PRIOR to performing any service; and must be signed and dated by the physician, PA, or ARNP before any service is provided. 
6. The evaluation cannot occur on the same day the  referral or script was signed by the physician.
7. A new script or referral must be obtained for each evaluation (including re-evaluations). Copies of the script and/or referral must be submitted as part of the required documentation for each prior authorization request.
8. The GN modifier must be included on the HCA12a line item for 92506 as well as the line item(s) for any therapy services requested.
Refer to letter 2013-05 for acceptable referral documents and instructions.

2/26/2013

All Medical Home Providers

All Medical Home Providers

Due to changes in the OHCA Call Center the SC-13, Provider Change Request form, will be updated to reflect a new fax number.  The new fax number will be (405) 917-7374. Medical Home providers will need to replace any copies of the current SC-13 form with the new form (revision date 3-1-13) beginning Feb. 28th, 2013. Please continue to use the current form until then.  SC-13 forms faxed to the old number of (405) 782-8780 will not be received after Feb. 27th 2013.

2/19/2013 Prior Authorization Requests

Title: Prior Authorization Requests

Run Date: 2/19/13 – 05/05/13

PV Types: All

Message:

Effective April 1, 2013, the Medical Authorization Unit (MAU) will no longer pend for additional documentation to providers submitting incomplete / incorrect prior authorization requests (PARs).  All incomplete / incorrect PARs will be cancelled and the provider will be required to submit a new PAR.  The 30-day-retro rule will remain in effect for all PARs submitted to the MAU.  For all PAR-related questions, please call the OHCA Call Tree at (800)522-0114.

2/7/2013 
 
Infectious Agent Detection by Nucleic Acid

Title: Infectious Agent Detection by Nucleic Acid

Run Date: 02/07/2013 – 03/24/2013

PV Type: 28  – Laboratory
SPC: 280 – Independent Lab
281 – Mobile Lab

This letter is a reminder of the billing requirements for infectious disease molecular diagnostic testing, specifically the use of CPT code 87798 (Infectious agent detection by nucleic acid, not otherwise specified; amplified probe technique, each organism) versus CPT code 87801 (Infectious agent detection by nucleic acid; amplified probe technique; multiple organisms). 

When using nucleic acid amplification techniques to test for a single infectious organism that lacks a specific CPT code in the 87470-87660 range, billing a single unit of CPT code 87798 is appropriate.  When nucleic acid amplification techniques are used to test for more than one infectious organism in a specimen, whether or not a specific CPT code in the 87470-87660 range is available (such as in an infectious disease panel), billing a single unit of CPT code 87801 is appropriate.  

OHCA has determined that billing multiple units of CPT code 87798 rather than a single unit of 87801 has led to incorrect reimbursement of services, denial of services, overpayments, and recoupments.  OHCA will allow only one unit of 87798 or 87801 for single or multiple-organism tests, respectively, to ensure that infectious disease testing services are paid appropriately.

As you may be aware, CPT codes 87631-87633 were introduced in 2013 for procedures that detect multiple respiratory viruses in a single multiplex reaction.  These codes are not covered services at this time.

2/6/2013 NPI Crosswalk Webinar

Title: NPI Crosswalk Webinar

Run Date: 02/06/2013 – 02/22/2013

PV Types: All

OHCA and HP will host a NPI Crosswalk webinar on February 21, 2013 at 2:30 p.m.

This webinar will detail how to appropriately crosswalk an NPI number to the appropriate Medicaid billing or rendering ID and the appropriate legacy provider ID number. Additional information (when needed) such as zip+4, contract code and taxonomy code details will be discussed.

Note:  This Webinar is intended for those that bill electronically NOT for providers who are submitting claims directly on the SoonerCare Secure Website. NPI Crosswalk for Medicare Crossover claims will not be discussed in this presentation.

Register today: 
http://www.okhca.org/providers.aspx?id=110&parts=7557_7559.

1/31/2013

520 – Banner #520 / Global – original message posted 12/12/2011 – 01/27/2012

520 – Banner #520 / Global –
original message posted 12/12/2011 – 01/27/2012

Title: PSYCH Testing Info - Updated

Run Date: 01/30/2013 – 03/15/2013

PV Type: 11, 53
 Spc: 110, 112, 121, 115, 535, 536, 585

Dear Behavioral Health Provider,

Beginning January 31, 2013 you can call OHCA to determine if a member has had previous testing within the last year.

Call 405-522-7055. OHCA staff will be able to assist.  If you need to leave a message, we will call back as soon as possible.

If you have any questions Please call the OHCA call center at 1-405-522-0114.

1/31/2013

Speech PA Requirement Global

Speech PA Requirement Global

A Prior authorization is required for ALL speech therapy services including evaluations.  Providers must submit a Prior Authorization Request for the evaluation and requested therapy services along with a copy of the physician’s prescription, OHCA form SC-10, or hospital or clinic’s referral form indicating the specific service(s) for which member has been referred. The referral/order must be signed and dated by the physician, PA, or ARNP prior to the date of the evaluation.

1/28/2013 Skilled Nursing Facility Part-A Crossover Claims
 

Title: Skilled Nursing Facility Part-A Crossover Claims

Run Date: 01/29/2013 – 03/15/2013

PV Types: 30 – Nursing Facility
  35 – Skilled Nursing


Dear Nursing Facility Provider:

The Governor has approved rule changes allowing the OKHCA to pay 100% of the deductibles and co-insurance on Medicare Skilled Nursing Facility Part –A Crossover Claims. This message is to notify you of this change for services rendered February 1, 2013 and after. 

The crossover claims file automatically and this requires only a change on our part, which has been made. Thank you for your services.

1/28/2013 Webinar Reminder

Title: Webinar Reminder

Run Date: 01/28/2013 – 01/30/2013

PV Types: All

OHCA and HP Enterprise Services are excited to announce a Webinar training session on Care Management 1/29/13.

SoonerCare’s Population Care Management (PCM) Department offers a wide variety of services for SoonerCare members. This webinar will provide orientation to the structure of the department and the services offered by the three work units in the PCM department.  We will explore available services such as Obstetrical-related Case Management, Pediatric-related Case Management, Out of State coordination, ER Utilization management and Social Service Coordination. We will also discuss our chronic care initiatives managed through our Chronic Care Unit and Health Management Program.

This webinar will be particularly helpful for primary care providers and their practice staff such as case managers, referral coordinators and office nurses. The information will also be helpful to staff of specialty provider offices, particularly OB practices and those focused on chronic illness. This webinar is limited to the first 75 registrants.

To register for the webinar, please visit: http://okhca.org/xwebinars.aspx 

1/22/2013 Care Management Webinar

Title: Care Management Webinar

Run Dates: 01/16/2013 – 01/29/2013

PV Types: All

OHCA and HP Enterprise Services are excited to announce a Webinar training session on Care Management. SoonerCare’s Population Care Management (PCM) Department offers a wide variety of services for SoonerCare members.

This webinar will provide orientation to the structure of the department and the services offered by the three work units in the PCM department.  We will explore available services such as Obstetrical-related Case Management, Pediatric-related Case Management, Out of State coordination, ER Utilization management and Social Service Coordination. We will also discuss our chronic care initiatives managed through our Chronic Care Unit and Health Management Program. 

This webinar will be particularly helpful for primary care providers and their practice staff such as case managers, referral coordinators and office nurses. The information will also be helpful to staff of specialty provider offices, particularly OB practices and those focused on chronic illness.

This webinar is limited to the first 75 registrants. To register for the webinar, please visit: http://okhca.org/xwebinars.aspx 

1/16/2013 SoonerCare 101

TITLE: SoonerCare 101

Run Date: 01/16/2013 – 03/16/2013

PV Types: All

Sign up for SoonerCare 101 now!

Oklahoma SoonerCare 101 is designed to educate office staff about billing and procedural aspects of Oklahoma SoonerCare. There are two classes in a one-session format: Introduction to Oklahoma SoonerCare and the Provider Secure Site. Class curriculum is applicable to all provider types.

These sessions are held in Oklahoma City and Muskogee on the first Thursday every other month.

Go to http://okhca.org/101_training.aspx to register today!

1/14/2013
  
Billing for Molecular Pathology Codes
 

Title: Billing for Molecular Pathology Codes

Run Date: 01/14/2013 – 03/01/2013

PV Type: 28 – Labs

Dear Laboratory Provider:

This message clarifies billing requirements for claims involving molecular pathology CPT codes in the 81200-81479 range.  Because these codes are manually priced, providers will need to submit an attachment (itemized invoice of services performed) with any claims that include molecular pathology procedures. Claims involving molecular pathology procedure codes in the 81200-81479 range that are submitted without an attachment will be automatically denied.

Please feel free to contact Alison Martinez, Ph.D. at alison.martinez@okhca.org with any questions.

1/11/2013 Title: Safety Items Exclusion

Title: Safety Items Exclusion

Run Date: 01/11/2013 – 06/30/2013

PV Types: 25 – DME 31 – Physicians


Effective January 1, 2013 OHCA has determined that TXIX coverage will exclude coverage of safety items such as adaptive full-length side safety rail beds, manual or electric safety bed systems, bed exit monitors, fire extinguishers, first aid kits, restraints, smoke and carbon monoxide detectors, and telephone alert systems.

1/3/2013  2013 EHR Incentive Attestations 

Title: 2013 EHR Incentive Attestations 

Run Date: 01/02/2013 – 03/31/2013 

PV Types: 01- Hospital 

31- Physicians
52- State Employed Physicians
09- Advance Practice Nurse
27- Dentist
10– Mid-level Practitioners
 

OHCA is currently upgrading its EHR attestation system to accommodate the changes for the 2013 participation year. Until further notice, we are unable to accept any attestations for the 2013 participation year. We apologize for any inconvenience. 

For those eligible professionals that still need to submit attestations for the 2012 participation year may continue to do so. 

1/2/2013  2013 New Call Center Hours 

Title: 2013 New Call Center Hours 

TO: All Providers 

Run Dates: 01/02/2013 – 02/17/2013 

Due to changes in call center operations, the hours for the provider customer service unit will change from 7:30am -5:30pm to 8:00am to 5:00pm effective January 2, 2013. OHCA apologizes for any inconvenience this change in business hours might cause. Thank you for your continued service to Oklahoma SoonerCare members.