Global Messages

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2019 Global Messages
2018 Global Messages
2017 Global Messages
2016 Global Messages
2015 Global Messages
2014 Global Messages
2013 Global Messages
2012 Global Messages
2011 Global Messages
2010 Global Messages
2009 Global Messages
2008 Global Messages
2007 Global Messages
2006 Global Messages  

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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