Global Messages

Date Posted

Title

Message

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.

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. 

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.

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

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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 

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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!

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.

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.

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.

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.