Posted
Date
|
Subject
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Message
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| 9/2/2010 |
Attention: Hospitals using the Newborn |
Title: Attention: Hospitals using the Newborn [NB1] Application
Run Date: 09/01/2010 – 09/15/2010
PV Types: 01 – Hospitals
MESSAGE:
The OHCA secure website will be undergoing maintenance beginning Friday, 09/03/2010 at 5:00 pm until Tuesday, 09/07/2010 at 7:00 am. The Newborn [NB1] application will be unavailable during this time.
OHCA is preparing to go-live with SoonerCare online enrollment. If you wish to assist your clients with SoonerCare enrollment you can access www.mySoonerCare.org and submit applications beginning September 7th.
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| 8/31/2010 |
Treatment Plan for Private Duty Nursing Authorization Requests |
Title: Treatment Plan for Private Duty Nursing Authorization Requests
Run Date: 08/26/2010 – 10/10/2010
PV Types: 05 – Home Health Agency, Spc: 050 – Home Health Agency, 051 – Specialized Home Nursing Svs
Prior Authorization requirements for Private Duty Nursing Services: Authorizations require a current treatment plan for the member, signed by the member’s attending Physician.
Effective immediately, a signed copy of current 485-Plan of Care (Home Health Certification) or Plan of Care must be included in the initial authorization request for private duty nursing services, along with the HCA-12A, HCA-13A and letter of medical necessity for all initial authorization requests. A copy of current 485-Plan of Care will be required every 60 days, per current amendment process to continue the authorization for private duty nursing services.
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| 8/30/2010 |
Correction to OHCA 2010-07: re Occupational Therapy Svs |
Title: Correction to OHCA 2010-07: re Occupational Therapy Svs
Run Date: 08/30/2010 – 10/13/2010
PV Types: OT/PT, 01 - Hospital, 17 – Therapist, 170 – Physical Therapist, 171 – Occupational Therapist, 174 – OT Assistant, 175 – PT Assistant, 336 – Physical Medicine & Rehab Practitioner
Please note the following correction to OHCA 2010-07, dated 02/12/2010, Dear Provider Letter, paragraph 5: “…when this service is rendered in an outpatient hospital-based facility, the claim should be submitted on a UB claim form with both the revenue code 420 (PT) or 320 (OT) and the CPT code 97542…”
Please note that the correct revenue code for OT is 430. The 320 (OT) revenue code is incorrect.
We apologize for any inconvenience this may have caused. Thank you for your continued services to Oklahoma’s SoonerCare Members.
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| 8/27/2010 |
2010 Fall Training |
Title: 2010 Fall Training
Run Date: 08/26/10-10/31/10
PF Type: All
PLEASE JOIN US FOR THE 2010 PROVIDER FALL WORKSHOP!!
Providers who attend will receive beneficial information concerning SoonerCare policies and programs, the Electronic Health Record Incentive and much more!
REGISTER TODAY!
Information and registration is available at: http://okhca.org/providers.aspx?id=110&parts=7557_7559
REMINDER: Click the “Submit Registration” button to finish your registration. You will then receive your confirmation e-mail which will include the physical location of the workshops as well as your selected classes and times.
The first stop on the 2010 Fall Training calendar is Durant, OK on September 21st, followed by: Tulsa, September 29th - 30th; Lawton, October 14th; and, will conclude in Oklahoma City, October 26th – 27th.
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| 8/26/2010 |
Electronic Remittance Advice (ERA) files for
August 18, 2010
|
Title: Electronic Remittance Advice (ERA) files for August 18, 2010
Run Date: 08/24/2010 – 11/24/2010
PV TYPES: All
ATTENTION:
All providers that receive the 835 Electronic Remittance Advice
MESSAGE:
Please be advised that all ERA files for warrant date August 18, 2010 will be re-generated and re-posted. This action is necessary as formatting issues with several ERA files contained errors or missing information. Re-posting these ERA files DOES NOT affect the warrant or check amount for August 18th.
If you have any questions, please contact the EDI Department at 405-416-6801.
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| 8/19/2010 |
Mass Adjustment – Region 52 |
Title: Mass Adjustment – Region 52
PV Types: All
Run Date: 08/19/2010 – 10/04/2010
Message:
OHCA is processing a mass adjustment that will be reflected on provider’s remit throughout the month of August. The ICN will start with a 52. This adjustment was done to correct claims with the fee schedule updates that were to occur on 07/01/2010.
Unfortunately, not all rates were updated prior to 7/1/2010 so some claims processed incorrectly.
Over 430,000 claims have been reprocessed. Some claims have paid more, some claims have paid less and there have been no changes to some claims.
We apologize for the inconvenience this has caused.
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| 8/19/2010 |
Accreditation Clarification Deadline 01/01/2011 |
Title: Accreditation Clarification Deadline 01/01/2011
Run Date: 08/19/2010 – 10/31/2010
PV Types: 250 – DMEPOS Suppliers
Message:
If your company is currently accredited by an approved Accreditation organization, you may submit a copy of your certificate at the time of contract renewal. You will be notified of the contract renewal period during the Fall of 2010. All DME contracts must be renewed by January 31, 2011.
It is not necessary to submit the accreditation certification at this time.
Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org
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| 8/10/2010 |
Sterilization Consent Forms |
Title: Sterilization Consent Forms
Run Date: 08/04/2010 – 09/19/2010
PV Types: 01, Hospital, 02, ASC, 08, Clinic, 31, Physician
Message:
Pursuant to 42 CFR §441.2455, every sterilization requires that a consent form must be signed at least thirty days prior to the actual procedure, with few exceptions. The consent form expires one hundred and eighty days following signature. These forms are required to be filed with both the hospital and physician claims. We have also recently added Spanish versions of this form for your use on our website.
It is imperative for all providers to understand that the consent forms must be signed at least 30 days prior to the actual sterilization or that the physician attests that it meets one of the allowable exceptions as noted on the form. The Oklahoma Health Care Authority will deny claims in which the consent form was not signed at least 30 days prior to the procedure.
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| 8/10/2010 |
Revision/Clarification: Authorization for 92526 |
Title: Revision/Clarification: Authorization for 92526
Run Dates: 08/10/2010 – 09/25/2010
PV Types: 17 – Therapist, Spc: 170 – Phys Therapist, 171 – Occupational Therapist, 173 – Speech/Hearing Therapist, 174 – Occup Ther Asst, 175 – Phys Ther Asst, 182 – Speech/Hearing Clinic
Revision/Clarification:
When requesting authorization for 92526, if the member has a current occupational or speech therapy please submit an amended PA with supporting documentation and appropriate modifier for the service requested. Please note the 30-day retroactive rule applies.
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| 8/9/2010 |
Individually Contracted SC LBHP’s contracted as a Group Practice member
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Title: Individually Contracted SC LBHP’s contracted as a Group Practice member
Run Date: 07/29/2010 - 09/17/2010
PV: Type: Mental Health Pv – 11, LBHP - 53, Spc: LMFT – 585, LADC – 586, LCSW – 115, Lic Psych – 112, LBP - 535, LPC - 121
Message:
RE: Individually Contracted Sooner Care Licensed Behavioral Health Providers (this includes LMFT, LCSW, Licensed Psychologists, LBP, LPC, and LADC) who are contracted as a member of a Group Practice.
Prior Authorizations - Use ONLY your individual provider ID number for ALL CDC submissions, Notification of CDC Submissions and any other authorization submissions to APS Healthcare, Inc. DO NOT use your Group ID.
Claims Submissions - Use your Group ID number in the "billing provider" field and your Individual ID number in the "rendering provider" field.
**Existing Authorizations under your Group ID will need a correction request faxed into APS asking for the authorization to be changed to your Individual Provider ID number. Be sure to include what that number is.**
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| 7/26/2010 |
PA Requirements for Wheelchair Accessories |
Title: PA Requirements for Wheelchair Accessories
Run Date: 07/27/2010 – 09/30/2010
PV Types: SPC 250
Message:
Effective with dates of service after August 1, 2010, the Prior Authorization requirements for Wheelchair Accessories have been added. Please see list of HCPCS codes affected at the Durable Medical Website at
www.okhca.org. http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669
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| 7/21/2010 |
Request for Medical Authorizations |
Title: Request for Medical Authorizations
Effective 08/15/2010
Run Dates: 07/21/2010 – 09/06/2010
PV Types: All
Message:
Effective August 15, 2010 the Medical Authorization unit will only process prior authorization submissions that utilize the 09/02/2009 revised Form HCA-12A. Any prior authorization requests submitted with outdated HCA-12A forms will not be processed.
Please remember to submit all prior authorizations with the revised HCA-12A, HCA-13A and CMN if applicable and all required medical necessary documents.
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| 7/21/2010 |
Update: OHCA Letter 2010-41 – ADM Referrals |
Title: Update: OHCA Letter 2010-41 – ADM Referrals
Run Date: 07/20/2010 – 09/05/2010
PV Types: All
You recently received OHCA letter 2010-41 concerning Administrative Referrals for Specialty Services. The contact information for your requests was inadvertently omitted from the referral form SC-14. This information has been updated to reflect the appropriate telephone and fax numbers for your requests.
Specialty service providers who are unable to obtain a PCP referral and are requesting consideration from OHCA should begin using the SC-14 form now. All prospective requests are currently reviewed for medical necessity. Retrospective requests will also be reviewed for medical necessity in the near future. Beginning Sept. 1, 2010 documentation of medical necessity will be required for all retrospective administrative referrals.
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| 7/20/2010 |
MHSAS Member Eligibility - Clarification |
Title: MHSAS Member Eligibility - Clarification
Run Date: 07/20/2010 – 09/05/2010
PV Types: All
Message:
Eligibility status of MHSAS has been added to the OHCA Member Eligibility Verification file on the OHCA Secure Site.
This is an additional benefit which covers Mental Health and Substance Abuse services only for those who meet the medical necessity and other requirements to be seen by an ODMHSAS contracted agency.
Questions please contact: erin.meyer@okhca.org
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| 7/20/2010 |
Dental Authorization Requests – Mailing Address |
Title: Dental Authorization Requests – Mailing Address
Run Date: 07/19/2010 – 09/05/2010
PV Types: 27; spc 271, 272, 273, 274
Message:
Effective immediately, please mail all Dental Authorization requests to:
OHCA Dental Unit
2401 N.W. 23rd Street/ Suite 1-A,
Oklahoma City, Oklahoma 73107
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| 7/19/2010 |
School Based Billing Rates |
Title: School Based Billing Rates
Run Date: 07/16/2010 – 08/31/2010
PV Types: 12 – School Corp, Spc: 120 – School Corp
Message:
Effective 7/1/2010 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
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| 7/8/2010 |
Fee Schedule Update
|
Title: Fee Schedule Update
Run Date: 07/08/2010 – 08/22/2010
PV Types: All
Please note the following additional information related to the below listed Global Message posted 06/29/2010.
1. When the Fee Schedule was updated, this update included elimination of consultation codes. Please use the appropriate E&M CPT code based on the service provided.
2. If you have any questions, please contact the HP Call Center at (800) 522-0114.
--------------------------------------------
Original Message to all Providers: This is our annual reminder that we rebase our fee schedule effective July 1 of each year. This allows us to incorporate all Medicare fee schedule changes and follows our current approved methodology. The previously approved rate cut of 3.25% is still in effect.
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| 7/8/2010 |
Outpatient Behavioral Health Claims
|
Title: Outpatient Behavioral Health Claims
Run Date: 07/07/2010 – 08/21/2010
PV Types: 11, spc: 110, 111, 118
Message:
Currently, when submitting a claim for outpatient behavioral health services, providers are receiving a denial message stating that a service/code requires ‘manual pricing’.
OHCA is researching this claims processing issue and hopes to have this it corrected as soon as possible.
OHCA will notify you once the system is set up to correctly process your claims so that you can submit claims or void off and refile your claims that have denied for this error code.
Please do not call the helpline referencing this issue as they cannot assist you with this problem.
Thank you for your continued support and services.
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| 7/6/2010 |
ODMHSAS Contracted Providers |
Title: ODMHSAS Contracted Providers
Run Date: 07/05/2010 – 08/20/2010
PV Types: SPC 118 – Mental Health, ODMHSAS
Message
As a reminder to ODMHSAS contracted providers, until your ODMHSAS contract/budget has been returned and set up, all claims for ODMHSAS-only services will be denied. It is recommended by ODMHSAS that providers not submit claims until this part of the contract/budget process has been completed.
Claims which have been submitted and are in a denied status do not need to be resubmitted at this time, and you do not need to call about these denials. It is strictly a ODMHSAS contract/budget issue at this time.
Any questions related to your ODMHSAS contract status should be directed to the ODMHSAS Helpdesk at helpdesk@odmhsas.org.
Thank you.
|
| 6/29/2010 |
To all Providers |
To all Providers
This is our annual reminder that we rebase our fee schedule effective July 1 of each year. This allows us to incorporate all Medicare fee schedule changes and follows our current approved methodology. The previously approved rate cut of 3.25% is still in effect. If you have any questions please contact provider services at 1-877-823-4529.
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| 6/28/2010 |
DMEPOS Accreditation Deadline January 1, 2011 |
Title: DMEPOS Accreditation Deadline January 1, 2011
Run Date: 07/01/2010 – 09/30/2010
PV Type: 250- DMEPOS Suppliers
Message:
Effective January 1, 2011, all suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) must be accredited by a Medicare deemed accreditation organization for quality standards for DMEPOS suppliers to bill the SoonerCare Program in accordance with OHCA Policy 317:5-210 (revised 11/1/07).
This accreditation requirement includes all Home and Community Based Services (HCBS) waiver providers as well unless otherwise noted below.
Providers that provide the following products exclusively are exempt: 1. Personal Emergency Response Systems; 2. Architectural Modifications; 3. Vehicle Adaptations
The Medicare deemed accreditation organizations list can be located at http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669
Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org
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| 6/14/2010 |
Edit 5014 |
Title: Edit 5014
Run Date: 06/08/210 – 07/23/2010
PV Type: 01, 010, 011, 012, 014
Message:
OHCA processed a mass adjustment on June 3, 2010 to correct claims that were paid in error related to edit 5014. This edit is for outpatient hospitals claims to prevent more than one outpatient hospital claim for the same patient and the same date of service from paying to the same facility. The edit was inadvertently turned off for claims billed and paid between February 28, 2010 and May 18th, 2010. If you have received payment on more than one outpatient claim for the same patient and the same date of service, your monies may be recouped. You will receive this information on a subsequent remittance advice.
We apologize for the inconvenience.
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| 6/8/2010 |
3rd Quarter DSH Payments |
Title: 3rd Quarter DSH Payments
Run date: 06/08/2010 – 07/25/2010
PV Types: 01; 010, 011, 012, 014
Message:
The 3rd quarter FFY10 DSH payment has been processed and will be issued on provider’s 6/16 remit.
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| 5/11/2010 |
Inpatient Admissions
|
Title: Admission Claims
Run Date: 05/11/2010 – 06/25/2010
PV Type: 01 – Inpatient Facilities
Message:
When notified by APS that medical records are necessary to evaluate a claim, please submit these records timely.
If you wait until the payment has been recouped before you send records you must submit a new claim for your records to be reviewed.
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| 5/11/2010 |
Billing Same DOS on the Same Claim/Edit 5017 |
Title: Billing Same DOS on the Same Claim/Edit 5017
Run Date: 05/10/2010 – 06/25/2010
PV Types: 31, Physician 52, State Employed Physicians 10, Mid-level Practitioner 09, Advance Practice Nurse 25, DME/Medical Supply Dealer
Message:
We have modified our claims processing system to edit claims for like-providers only. This means provider claims will edit against other provider claims and DMEPOS claims will edit against other DMEPOS as opposed to all claims.
We have backdated this change to 1/1/2010. If you have specific questions please call Provider Service at 1-877-823-4529, Option 2.
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| 5/6/2010 |
E&M Codes |
Title: E&M Codes
Run Date: 05/04/2010 – 06/19/2010
PV Types: All
A new edit was implemented January 1, 2010 that looked at E&M codes and how they were billed. The system was set to look at the billed date. This caused claims to deny if the new patient appointment was billed after the follow-up appointment. The system has been modified to process the claim based on the date of service. This change is effective today, May 4, 2010. You can correct any previously denied claims for DOS January 1, 2010 and after.
Please call Provider Services at 1-800-522-0114 if you have any questions.
Your comments helped us realize we needed to review our process. Thank you and we apologize for the inconvenience this may have caused.
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| 5/4/2010 |
DMEPOS Rate Change – A4215 – Needle, sterile, any size, each |
Title: DMEPOS Rate Change – A4215 – Needle, sterile, any size, each
Run Date: 05/04/2010 – 06/30/2010
PV Type: 240 – Pharmacy;
250 DME/Medical Supply Dealer
The rate for HCPCS Code A4215 (Needle, sterile, any size each) has been adjusted from $0.89 each to $0.42 each effective May 1, 2010. This rate includes the 3.25% Provider rate reduction in effect.
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| 5/4/2010 |
w HCA12 form - Implementation Postponed |
Title: New HCA12 form - Implementation Postponed
PV TYPES: All
Run Dates: 05/03/2010 – 06/18/2010
Message:
Please note that the implementation of the new HCA12 form that was previously posted on the OHCA prior authorization site has been postponed until further notice.
All providers will need to continue to use the HCA13A form when submitting prior authorizations until further notice.
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| 4/29/2010 |
Registration for Lawton Spring Training |
Title: Registration for Lawton Spring Training
Run Date: 04/29/2010 – 05/11/2010
PV Types: All
Message:
Registration for the Lawton workshops will close next Tuesday, May 4th. The Lawton workshop will be held on May 12th and walk up registration will be available.
Oklahoma City workshops (May 19th & 20th) and Tulsa workshops (May 25th & 26th) will remain open until one week prior to the workshops.
Please register today!
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| 4/28/2010 |
Edit 5017
|
Title: Edit 5017
Run Dates: 04/27/2010 – 06/12/2010
PV Types: DME – 25; 250
Message:
Thank you for your comments related to edit 5017. We are modifying our system logic to address some of the claims processing concerns you experienced. These changes will be effective within the next three weeks.
Until these changes go into production if you provide two separate services on the same day, i.e. a DME service and a non-DME service, please file your DME claim first. Filing the DME claim first will allow you to bill the other services and not be exposed to the 5017 edit.
We apologize for any inconvenience this has caused.
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| 4/22/2010 |
BRCA Testing |
Title: BRCA Testing
Run Date: 04/22/2010 – 06/05/2010
Pv: Labs: 28, Independent Lab: 280, Mobile Lab: 281, Oncologists: 329
Message:
Effective May 1, 2010, the maximum number of units allowed for the following procedure codes will be reduced to 25 units per day.
83898- Molecular diagnostics; amplification, target, each nucleic acid sequence
83904- Molecular diagnostics; mutation identification by sequencing, single segment, each segment
83909- Molecular diagnostics; separation and identification by high-resolution technique (e.g., capillary electrophoresis)
Please note: The OHCA does not currently reimburse for BRCA 1 or BRCA 2 screening.
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| 4/21/2010 |
Dental Procedure Code D0140
|
Title: Dental Procedure Code D0140
Run Date: 04/20/2010 – 06/05/2010
PV Type: 27 – Dentist, Spc: 86 – Dental Clinic, 271 – General Dentistry, 272 – Oral Surgeon, 273 – Orthodontist, 274 – Pediatric Dentist
Message:
Dental Procedure Code D0140 no longer requires a tooth number on your claim, effective 1-1-2010.
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| 4/8/2010 |
EP Survey: Next Step |
Title: EP Survey: Next Step
Run Date: 04/08/2010 – 05/23/2010
PF Type: All
As a contracted SoonerCare provider, you may qualify for health information technology incentive payments under a new Medicaid electronic health record (EHR) Incentive Program. Federal legislation designates that cost reimbursement money be made available to certain providers who adopt, enhance, or upgrade EHR technology. Please take a few minutes to visit OHCA’s public website at http://www.okhca.org/EHR-incentive and complete a brief survey. Your input will provide the information needed to make incentive funds available to SoonerCare providers and create a successful program.
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| 4/8/2010 |
2010 Spring Training |
Title: 2010 Spring Training
Run Date: 04/08/2010 – 05/27/2010
PF Type: All
Please join us for the 2010 Spring Workshops! Providers who attend will get up-to-date beneficial information on the SoonerCare programs.
Register today!
Information and registration is available at: http://okhca.org/providers.aspx?id=110&parts=7557_7559
Durant, OK will be the first stop on April 27th followed by: Lawton, May 12th; Oklahoma City, May 19th – 20th; and, conclude in Tulsa, May 25th - 26th.
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| 3/29/2010 |
Co-Pay Increase & Provider Rate Reduction |
Title: Co-Pay Increase & Provider Rate Reduction
Run Date: 03/26/2010 – 05/10/2010
PV Types: All
Effective April 1, 2010, all provider rates will reflect a 3.25% across-the-board rate reduction. The updated fees will be available on your personal secure website.
Also starting April 1, 2010, co-pays for non-pregnant adults in SoonerCare (age 21 and older) will be as follows:
$10.00 per day for inpatient hospital stays with a maximum total of $90.00 per hospital stay.
$3.00 for most office and home visits. This includes visits with members’ PCP, optometrists, home health agencies, durable medical equipment providers and outpatient behavioral health providers.
For prescription drugs, there is no co-pay for preferred generic prescriptions. A list of the Zero Copay Drug List can be found at www.okhca.org/providers/rx.
There will be a $2.00 co-pay for prescriptions that cost up to $29.99 and a $3.00 co-pay for prescriptions that cost $30 or more.
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| 3/22/2010 |
School Based Training
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Title: School Based Training
Run Date: 03/22/2010 – 04/07/2010
PF Type: Type 12 ; Specialty Type 120
School-Based Training is scheduled for the following dates:
April 1, 2010 – McAlester, OK
April 6, 2010 – Oklahoma City, OK
Please Register for training through OHCA website at:
http://www.okhca.org/schoolbased
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| 3/5/2010 |
Update: Forms & Documentation for PA Requests re HROB Svs
|
Title: Update: Forms & Documentation for PA Requests re HROB Svs
Run Date: 03/04/2010 – 04/19/2010\PV
Type: All
Message:
This is an update to Provider Letter OHCA-2007-52, Item 3, which states “The MFM completes and signs the High Risk OB Treatment Plan / Prior Authorization (PA) Request (CH-17) and submits the following documents to the OHCA Medical Authorization Unit for prior authorization…”
Update: It is the requesting provider’s responsibility to complete the High Risk OB (HROB) Treatment Plan / Prior Authorization (PA) Request (CH-17), whether the requestor is the primary OB provider or the Maternal Fetal Medicine (MFM) specialist. The requesting provider then submits the following documents to the OHCA Medical Authorization Unit for prior authorization: HCA-13A (PA Coversheet), CH-17 (both available on the OHCA website) and a comprehensive prenatal assessment. If the member is being co-treated by both a primary OB provider and an MFM, the OB provider should complete and submit the HROB Treatment Plan (CH-17), along with a copy of the MFM consultation and recommendations.
For questions regarding this update: (800) 522-0114 or (405) 522-6205.
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| 3/5/2010 |
Batch 270/271 Submitters & Receivers – Redetermination Date Changes
|
Title: Batch 270/271 Submitters & Receivers – Redetermination Date Changes
Run Date: 03/04/2010 – 06/30/2010
PV Types: All
Message:
Beginning March 20th, 2010, the 271 Eligibility Response will no longer return a Redetermination Date for inactive clients in the Subscriber Eligibility/Benefit Date segment in Loop 2110C.
Please make any necessary modifications to your system to handle this change.
For any questions, please contact the EDI Help Desk at (405) 416-6801.
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| 2/25/2010 |
PA requests with Photo Documentation
|
Title: PA requests with Photo Documentation
Run Date: 02/25/2010 – 04/08/2010
PV Types: All
Message:
To ensure timely review of Prior Authorizations that require photo documentation effective March 8, 2010 Prior Authorizations for these service must include either a CD of the photographs or a copy of the original photographs. These photos must be appropriately taken and adequately clear to demonstrate medical necessity. Original photographs, CD’s or other media items will not be returned.
Faxed copies of photographs will not be accepted.
|
| 2/25/2010 |
PA Process for Diabetic Strips and Lancets |
Title: PA Process for Diabetic Strips and Lancets
Run Date: 02/25/2010 – 04/08/2010
PV Types: 31 - Physician
322 - Endocrinologist/Internist, 318 - PCP’s (G.P.), 328 – OB/GYN, 250 - DME
Message:
The Prior Authorization (PA) process for diabetic strips and lancets has changed. Effective April 1st, 2010, members can receive 100 strips and 100 lancets per month without Prior Authorization. Requests for more than 100 strips and 100 lancets per month will require Prior Authorization for both children and adult SoonerCare Members. The following documentation is required for a 6-month PA: HCA13A, HCA12A, signed prescription indicating number of times member is testing per day, objective documentation from the last 6 months to support medical necessity for testing frequency, and a copy of the member’s current blood glucose log showing one month’s testing results.
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| 2/22/2010 |
DMEPOS Advisory Committee (DAC) |
Title: DMEPOS Advisory Committee (DAC)
Run Dates: 2/23 /10 thru 3/9/10
PV Types: 250 – DME/Medical Supply Dealers
Message:
The Oklahoma Health Care Authority will be hosting a meeting with the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Advisory Committee (DAC) on March 9, 2010 to discuss related issues to DMEPOS for TXIX products and policy. The agenda for the meeting is now available at the DME webpage of the OHCA website. A list of the members of the committee and their contact information is provided for your reference at the website location as well. See link below.
http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669
The meeting will be held at the Oklahoma Health Care Authority, 4545 N Lincoln Blvd # 124, Oklahoma City, OK 73105 - 405-522-7300
- - - Sign in at 4:30 p.m. - - - Meeting from 5:00 p.m. to 7:00 p.m.
|
| 2/3/2010 |
New MHSAS member eligibility status in MMIS |
New MHSAS member eligibility status in MMIS
Members may show the new eligibility status of MHSAS in MMIS. This benefit only covers Mental Health and Substance Abuse services for those who meet the medical necessity and other requirements to be seen by an ODMHSAS contracted agency.
Questions please contact: erin.meyer@okhca.org
|
| 2/1/2010 |
Hysteroscopy |
58565 – Hysteroscopy, surgical: with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants
HCPCS has created the unique A4264 code to describe the implant. The previous provider letter # 2006-13, 3 Jan 2007, instructed you to bill L8699 for the implants. As of 3/1/10, L8699 will not be allowed. Use A4264 instead. 2 Units is the maximum. Maximum pricing remains the same.
Prior authorization will be required if either inpatient, outpatient or ASC place of service is requested. No prior authorization will be required if performed in an office setting.
REMINDER: As stated in the original provider letter, local anesthesia, including parasurgical anesthesia (64435), is NOT allowed in addition to A4264. |
| 1/10/2010 |
SC-10 SoonerCare Choice Referral Form |
Title: SC-10 SoonerCare Choice Referral Form
Run Date: 01/11/2010 – 02/26/2010
PV Type: All
The SC-10 SoonerCare Choice Referral Form is used by a provider to refer members to a specialist. This form should not be used as a prescription for services requiring prior authorization or as a substitute for the physician’s signature.
Effective 01/12/2010 the OHCA Medical Authorization staff can not process a PA request if the SC-10 Form is attached in lieu of a prescription or physician’s signature.
|
| 1/10/2010 |
Manual Pricing for Unlisted Surgical |
Title: Manual Pricing for Unlisted Surgical Procedures
Run Date: 01/07/2010 – 02/22/2010
PV Type: 31 – Physician, 52 – State Funded Physicians
Message:
To expedite the process of manually pricing claims on unlisted surgical procedures, please include the description of the actual procedure beside the procedure code on the 1500 form. Write the unlisted code beside the procedure description on the operative report.
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| 1/10/2010 |
Closing CPT Codes |
Title: Closing CPT Codes
Run Date: 01/11/2010 – 02/26/2010
PV Type: All
Message:
Effective 1/25/2010 the following CPT codes will no longer be open: 86702, 86703 and 87391. If these codes are used, claims must be submitted with appropriate documentation to support the medical necessity.
If you have questions please contact Provider Services at 1-877-823-4529, option #2.
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| 1/4/2010 |
Claims Adjustments |
Title: FYI - Claims Adjustments
Run Date: 01/04/2010 – 02/20/2010
PV Type: 01 – Hospitals
Message:
Processing difficulties experienced on December 22-24, 2009 resulted in UB Claims not to audit accurately.
Therefore, approximately 31,000 UB claims will be reprocessed the evening of January 4, 2010. Adjustments will run the week of January 11-15, 2010 to correct any claims that may not have properly audited. This fix will not affect region 92.
Your patience in awaiting the outcome of this fix is appreciated.
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