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Posted
Date

Subject

Message

12/20/2011 CDC Provider Enrollment

Title: CDC Provider Enrollment

Run Dates:12/20/2011 – 02/05/2012

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

Attention Behavioral Health Providers – CDC Provider Enrollment

In a letter dated 11/30/2011 from Mike Fogarty, CEO of the Oklahoma Health Care Authority, you were notified of the temporary lifting of prior authorizations for outpatient behavioral health, the termination of the Optum contract, and the Client Data Core (CDC) would be required to be submitted as a condition of payment. In preparation for submitting the CDCs, you will be receiving a letter from The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) in the next day or two. The letter from ODMHSAS is to guide you through the first part of the process to begin submitting CDCs again. The letter has information which is specific to each provider, so you must have it before you begin. If you do not receive this letter by 12/28/2011, you may contact gethelp@odmhsas.org.

This first step is to enroll the provider, then to ask which specific staff will need access to CDC data entry and access to reports. Not every staff member may need to be enrolled, just those who need access to the system. The process to enroll the provider and add 10 staff should take about 5 minutes. Within a day or two of enrolling staff members, they will receive an email notification asking them to enroll. If you would like to participate in an optional, 15 minute webinar, which will review this step in the process, please go to http://www.odmhsas.org/cdc_initial_provider_enrollment.htm to sign up.

Letter example: http://www.odmhsas.org/ProvEnrollExample.pdf
Where letter is being sent: http://www.odmhsas.org/ProvEnrollList.pdf

We look forward to working with you.

12/20/2011 278 Prior Authorization Request/Response Companion Guide Document Now Available

RE:  278 Prior Authorization Request/Response Companion Guide Document Now Available

The 278 Companion Guide document is now available. Please refer to the 278 Companion Guide Document and make any necessary changes to your system to request prior authorizations via this ASC X12 5010 format. Requesting prior authorizations via this transaction is NOT required by the OHCA and providers may continue using the existing process to request prior authorizations. All 5010 Companion Guide documents are located at: 5010 Companion Guides and NCPDP D.0 Payer Sheet.

   

Attention: Electronic 276 submitters: Updated 5010 Companion Guide Documents Available

Updates have been made to the 276/277 Companion Guide Document. E2 has been removed from the transaction identifiers at GS08 and ST03 segments.

Please refer to the updated 276/277 Companion Guide Document and make any necessary changes to your system.  The ASC X12 5010 transactions will be the standard format beginning 01/01/2012.  All 5010 Companion Guide documents are located at: 5010 Companion Guides and NCPDP D.0 Payer Sheet.

12/20/2011 Electronic 270 submitters: Updated 5010 Companion Guide Documents Available

Attention: Electronic 270 submitters: Updated 5010 Companion Guide Documents Available

Updates have been made to the 270/271 Companion Guide Document regarding proper placement of data in the ISA06 and ISA08 segments.  

Please refer to the updated 270/271 Companion Guide Document and make any necessary changes to your system.  The ASC X12 5010 transactions will be the standard format beginning 01/01/2012.  All 5010 Companion Guide documents are located at: 5010 Companion Guides and NCPDP D.0 Payer Sheet.

12/20/2011 Electronic 837P and 837D submitters: Updated 5010 Companion Guide Documents Available  

Attention: Electronic 837P and 837D submitters: Updated 5010 Companion Guide Documents Available  

Updates have been made to the 837P and 837D Companion Guide Documents regarding proper placement of the Rendering Provider ZIP+4 on these two transactions.  The ZIP+4 is necessary in some cases to crosswalk the NPI of rendering providers with more than one service location.

The 5010 837P and 837D Technical Reports have been interpreted such that the REF Rendering Provider Secondary Information segment at both the header and detail segment cannot be used with an NPI in the NM109 element of the same loop. As a result, OHCA is requiring the Rendering Provider's ZIP+4 information in the 5010 transactions to be entered in the NTE segment at the header and/or detail level on the 837P, and at the header level on the 837D. 

Please refer to the updated 837P and 837D Companion Guide Documents and make any necessary changes to your system.  The ASC X12 5010 transactions will be the standard format beginning 01/01/2012.  All 5010 Companion Guide documents are located at: 5010 Companion Guides and NCPDP D.0 Payer Sheet.

12/14/2011 PSYCH Testing

Title: PSYCH Testing

Run Date: 12/12/2011 – 01/27/2012

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

Dear Behavioral Health Provider,

Beginning December 13, 2011 you can call OHCA to determine if a member had had previous testing within the last year.

Call 405-522-7861. 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 1-800-522-0114.

12/13/2011 5010 Conference Call hosted by HP Enterprise SVS

Title: 5010 Conference Call hosted by HP Enterprise SVS

Run Dates: 12/13/2011 – 12/17/2011

Pv Types: All

Target Audience:  EDI batch file submitters

HP Enterprise Services will host a 5010 conference call on Friday, December 16th from 1:30 - 2:30 central time. 

The following topics will be discussed:

-     5010 testing update
-     Common 5010 errors
-     Companion Guide updates
-     SoonerCare specific changes for 5010 (CN1)
-     5010 Testing Request Form
-     Announcement of NCPDP D.0 “go live” date
-     Other news and announcements
-     Questions/Answers

All SoonerCare EDI submitters, billing agents, clearinghouses, VANS, and software vendors are welcome to attend this teleconference. 

Please contact the EDI Helpdesk with any questions at (405) 522-0114, option 2, 2.

Date:  Friday December 16, 2011
Time: 1:30 - 2:30 central time. 
Conference dial in number:  866-409-2889 Conference Code: 4931653160

12/12/2011 PSYCH Testing Run Date: 12/12/2011 – 01/27/2012

Title: PSYCH Testing Run Date: 12/12/2011 – 01/27/2012

PV Type: 11, 53

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

Dear Behavioral Health Provider,

Beginning December 13, 2011 you can call OHCA to determine if a member had had previous testing within the last year.

Call 405-522-7861. 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.

12/12/2011 Electronically Submitted Claims Only 4010 to 5010 Cutover Schedule – Extended Maintenance Period

Title: Electronically Submitted Claims Only 4010 to 5010 Cutover Schedule – Extended Maintenance Period

Run Dates: 12/12/2011 – 01/27/2012

PV Types:  All

4010 To 5010 Cutover Schedule – Extended Maintenance Period for Electronically Submitted Claims Only:

• OKMMIS will be down from Saturday December 31, 2011 at 6:00 p.m. until Sunday, January 1, 2012 at 5:00 a.m.

• Effective Saturday, December 31, 2011 at 6:00 p.m., all EDI claims submissions must be in ASCX12 5010 format.

Please refer to the Banner Messages listed on the OHCA Public Website at www.okhca.org/ for additional information.

12/8/2011 UPDATE from Conference Calls: BH PA, CDC Process

Title: UPDATE from Conference Calls: BH PA, CDC Process

Run Date: 12/08/2011 – 01/23/2012

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

Dear Outpatient Provider,

This information follows the first scheduled conference call hosted by ODMHSAS and OHCA regarding questions about the changes in the authorization/CDC process. Below are websites [that were referenced in the conference calls of December 6th & 7th, 2011] where forms and information related to CDC submission are available to you.

www.odmhsas.org/arc.htm   (DMH providers)

www.Odmhsas.org/arc2.htm (Non DMH providers)

12/7/2011 CPAP Authorization Guideline Revisions 

Title: CPAP Authorization Guideline Revisions 

Run Date: 12/08/2011 – 01/31/2012

PV Types: 250 DME Providers

Effective January 1, 2012, OHCA will implement new CPAP Authorization guidelines to align with CMS LCD # L11518 (Revised 10/1/2011).

  • Interpreting Physicians must be board-certified in sleep medicine;
  • Sleep diagnostic testing facilities must be accredited and follow state law;
  • Home Sleep Studies are NOT COVERED by OHCA;
  • Providers must show evidence of adherence to therapy for all members (not just those with AHI under 15) beyond the first three months of therapy;
  • Clinical benefit is demonstrated by face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of OSA are improved;
  • and, objective evidence of adherence to therapy is use of PAP greater than or equal to 4 hours per night on 70% of nights during a consecutive thirty (30) day period during the first three (3) months of initial usage  - from LCD

OHCA will offer a purchase option for members who qualify for continuation – see DME Website for Instructions - http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669

12/7/2011 Ultrasound Benefit Clarification re: Provider Letter 2011-54

Title:  Ultrasound Benefit Clarification re: Provider Letter 2011-54

Run Date: 12/07/2011 – 01/25/2012

PV Types: 31 – Physician
   091 – OB Nurse Practitioner
   181 – Maternity
   214 – High Risk Pregnant Women
   316 – Family Practitioner
   318 – GP
   323 - Neonatologist
   328 – OB/GYN
   335 – Maternal Fetal Medicine

In our recent Provider Letter 2011-54 sent last week, the portion in brackets below is not accurate. MFM alone or with the member’s chosen obstetric provider coordinate care and they will determine where the additional ultrasounds need to be performed.

We apologize for any confusion this might have caused.

Women deemed high-risk, based on criteria established by the OHCA,  may receive prior authorization for medically necessary enhanced benefits, which include six additional ultrasounds, [which must also be performed by an MFM]. Women who have a high-risk pregnancy can be cared for by a board certified diplomat in Maternal Fetal Medicine alone or along with her chosen obstetric provider. The CPT Codes for high risk ultrasounds are 76815, 76816 and 76817 and are only compensable for women deemed high risk by OHCA.

12/5/2011 Conference Calls: BH PA, CDC Process

Title: Conference Calls: BH PA, CDC Process

Run Date: 12/05/2011 – 01/20/2012

PV Type: 11, 53 Spc: 110, 112, 121, 585, 115, 535, 583, 536

Dear Outpatient Provider,

ODMHSAS, along with OHCA, will be hosting several conference calls to answer your questions about the changes in the authorization/CDC process. We have set aside the following times for your convenience.

Tuesday, December 6th @ 3:30 pm
Wednesday, December 7th @ 2:00 pm

• There is no need to be on both calls.  The information will be repeated.
• We can only host the first 100 callers so if you are unable to get on the first call, please try to get on the second call.
• If there are multiple individuals in a single location, please try to call from a single phone.
• *6 is the mute key.

Please use the following number and access code:

1-877-402-9757
access code: 9899630#

11/30/2011 TENS UNIT – PA Requirement Removed

Title: TENS UNIT – PA Requirement Removed

Run Date: 11/30/2011 - 01/31/2012

PV Types: 250 – DME/Medical Supply Dealers

Please be advised that effective January 1, 2012, OHCA will implement a change for TENS units.  NO Prior Authorization will be required for HCPCS codes E0720 and E0730.

E0720 – Transcutaneous electric nerve stimulation (TENS) device, 2 lead, localized stimulation.
E0730 – Transcutaneous electric nerve stimulation (TENS) device, 4 or more leads, for multiple nerve stimulation.

A physician signed copy of the HCA-39 (CMN for TENS devices) must be kept on file at the provider’s location showing evidence of a 30 day trial and follow-up by the physician prior to billing.  The HCA-39 must be kept on file at the provider’s location in case of an audit.
Contact Stan Ruffner at stan.ruffner@okhca.org with questions.

11/17/2011 Online-Generated Letters (Expirations)

Title: Online-Generated Letters (Expirations)

PV Types: All

Run Date: 11/17/2011 - Indefinite

OHCA is GOING GREEN! Look for upcoming notifications via email. If we do not have your email, please notify us at www.okhca.org or call OHCA Provider Contracts at (800)522-0114 Option #5. If you do not retrieve this information within 14 days, you receive a paper letter via the US postal service. Thank you for your support of the OHCA’s green effort!  

11/16/2011 5010 Testing Request Form

Title:  5010 Testing Request Form

PV Types: All

Run Date: 11/15/2011 – 01/01/2012

OHCA and HP will soon open up 5010 testing for all current trading partners.  If you have not done so already please submit a 5010 Testing Request form.  This electronic form is located on the OHCA website at: www.okhca.org/edi, under the “Resources” heading.

When you submit this form we will be able to convert your current trading partner agreements to the appropriate agreements for version 5010 HIPAA compliance testing purposes.  If you choose not to submit the form we will be unable to test with your organization.

Please contact the EDI Helpdesk with any questions at (800) 522-0114, option 2, 2.

11/16/2011 H2017 Billed with HW Modifier

Title: H2017 Billed with HW Modifier

Run Date: 11/15/2011 – 01/01/2012

PV Types: 11, Spc:  111, 118

For DOS after 10/1/2011 when billing H2017 the HW modifier must be in the 3rd position. If you have claims that have paid incorrectly, please void that claim and bill them according to the following sequence H2017 HE/HV/HH/HF, HQ, HW to get the appropriate rate.  

11/14/2011 BH – H2017 Billings for DOS after 10/01/2011

Title:  BH – H2017 Billings for DOS after 10/01/2011

Run Date: 11/14/2011 – 12/31/2011

PV Types: 110 – Outpatient Mental Health Clinic, 111 – Community Mental Health Center (CMHC), 118 – Mental Health/DMHSAS

There was a slight glitch in the claims file related to H2017 billings for DOS after 10/1/2011. It was not allowing the appropriate group therapy units to be billed.

This was corrected over the weekend. 

You can resubmit these claims for reprocessing. Remember to void your original claim so the system will not deny as a duplicate submission.

Thank you.

11/14/2011

5010 Conference Call & Webinar hosted by HP Enterprise Services

5010 Conference Call & Webinar hosted by HP Enterprise Services

Target Audience:  EDI batch file submitters

Marvin Dale

IN CASE YOU MISSED IT!

5010 Conference Call & Webinar hosted by HP Enterprise Services
Target Audience:  EDI batch file submitters

HP Enterprise Services will host a 5010 Webinar on Friday, November 18th from 1:30 – 2:30 central time.  The following topics will be discussed:  5010 testing update; 5010 Overview; The SoonerCare Approach to 5010 Implementation; Tips for Passing Compliance; NCPDP D.0;  NPI Crosswalk for 5010 ; What’s New:  Secure Site Changes, New EDI Transaction; Q&A

All SoonerCare EDI submitters, billing agents, clearinghouses, VANS, and software vendors that are familiar with loops and segments of the current 4010 requirements are welcome to attend this webinar event.  Future 5010 teleconferences and webinar events will also be offered, dates and times to be determined.

Date:  Friday November 18, 2011
Time: 1:30 -2:30 central time. 

1. View the presentation by clicking the following link and entering your name AND the participant key below: https://www.rooms.hp.com/attend/default.aspx?key=EP2BVB4WXE
Participant key:  EP2BVB4WXE

2. Listen to the presentation by dialing the following number and entering the conference pin code:
Conference dial in number:  866-409-2889 Conference Code: 4931653160

Please contact the EDI Helpdesk with any questions at (405) 522-0114, option 2, 2.

11/4/2011 Speech Therapy when English is not the Primary Language

Title: Speech Therapy when English is not the Primary Language

Run Date: 11/04/2011 - 12/19/2011

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

Effective immediately:

All speech therapy requests for children who are bilingual or for whom English is not the primary language must include the following information in the evaluation report:

  1. Primary language;
  2. The language that testing was conducted in;
  3. The language(s) in which therapy will be provided and
    the rationale for this.

Please make sure that goals address delay or disorder and specific problems.

10/27/2011 Notification Process for Admissions and Discharges from PRTF Providers

Title: Notification Process for Admissions and Discharges from PRTF Providers

Run Dates: 10/26/2011 – 12/10/2011

PV Types: 01, Spc:  013, 015

We need to make you aware of a slight change in the notification process for admissions and discharges from your facilities. 

Effective Monday, October 31, 2011, admission and discharge information needs to be faxed to 405-530-7236. This slight change will allow immediate update of the member file to insure appropriate payments are made for these members and has no impact on your interaction with Optum for Prior Authorizations.

A sample of the information needed on the form is included below for your information. You can find the form on the Optum website under “Provider & State Staff” tab in the inpatient forms section.

Residential Admit/Discharge Reporting Form: Please note this is to be completed for every admit and discharge (this includes upgrades and downgrades) RTC level of care. Please fax to 405-530-7236. Please print clearly.

  1. Member Name
  2. Member SoonerCare ID Number
  3. Admit Date to RTC Level of Care
  4. Discharge Date from RTC Level of Care
  5. Facility Name
  6. Facility Provider ID number
  7. Facility Phone Number
  8. Form Completed by

Remember to call Optum for all Prior Authorizations questions.

10/26/2011 5010 Webinar hosted by HP Enterprise Services

Title: 5010 Webinar hosted by HP Enterprise Services

Run Dates: 10/25/2011 – 10/29/2011

Pv Types: All

HP Enterprise Services will host a 5010 Webinar on Friday, October 28th from 1:30 – 2:30 central time.  The following topics will be discussed:  5010 Overview; The SoonerCare Approach to 5010 Implementation; Tips for Passing Compliance; NCPDP D.0;  NPI Crosswalk for 5010 ; What’s New:  Secure Site Changes, New EDI Transaction; Q&A

All SoonerCare EDI submitters, billing agents, clearinghouses, VANS, and software vendors that are familiar with loops and segments of the current 4010 requirements are welcome to attend this webinar event.  Future 5010 teleconferences and webinar events will also be offered, dates and times to be determined.

Please contact the EDI Helpdesk with any questions at (405) 522-0114, option 2, 2.

Date:  Friday October 28, 2011
Time: 1:30 -2:30 central time. 
Virtual room: https://www.rooms.hp.com/attend/default.aspx?key=EP2BVB4WXE 
Participant key:  EP2BVB4WXE
Conference dial in number:  866-409-2889
Conference Code: 4931653160

10/14/2011 Mirena IUD

Title:  Mirena IUD

Run Date: 10/24/2011 – 12/06/2011

PV Types: All

SoonerCare reminds providers offering Mirena® birth control that OHCA reimburses for one IUD without prior authorization within a 5-year period.

Additional IUDs require a prior authorization. Subsequent unit(s) must be medically necessary which does not include replacing an IUD product removed before the end of the 5-year IUD product life span because the member no longer wanted birth control.

10/19/2011 DMEPOS Provider Workshop

Title: DMEPOS Provider Workshop

Run Dates: 10/19/11 thru 11/4/11

PV Types: 250 – DME/Medical Supply Dealers

Please follow this link to register for the DMEPOS Provider Workshop scheduled to be held at the OHCA office in Oklahoma City on Monday, November 7, 2011 at 1:00 PM to 4:00 PM - http://www.okhca.org/dme-workshop.aspx

Space is limited so register soon. If you have specific areas of concern please indicate in the space provided on the registration.  Topics to be covered are new DME Repair Claims Process, REUSE Program Update, Oxygen CMN Review, and other agenda items as time permits.  Please sign in at the FAR NORTH entrance to Shepherd Mall located at 2401 NW 23rd St - Suite 1A, Oklahoma City, OK  73107.

Contact Stan Ruffner, DMEPOS Director at stan.ruffner@okhca.org if you have any questions about this workshop.

10/18/2011 PA Contract Renewals (Expirations)

Title: PA Contract Renewals (Expirations)

Run Date: 10/17/2011-12/01/2011

PV Types: 100 – Physician Assistants

Dear Primary Care Provider:

REMINDER: SoonerCare and Insure Oklahoma contracts for Physician Assistants will expire on January 31, 2012. OHCA requests that Physician Assistants who serve as PCPs for SoonerCare Choice or Insure Oklahoma renew their contracts before November 30, 2011. Because of system limitations, PCPs who have not completed contract renewals by November 30th will not appear in online provider directories and will not be able to receive new enrollments on their panels until the contract is renewed.

Please note that groups, physicians, and nurse practitioners who have PCP contracts do NOT have to renew at this time. Only Physician Assistant contracts expire January 31st.

If you have any questions regarding contract renewal, please call (800)522-0114 or (405)522-6205, option #5.

10/17/2011 5010 Conference Call Hosted by HP Enterprise Svs

Title: 5010 Conference Call Hosted by HP Enterprise Svs

Run Date: 10/14/2011 – 10/22/2011

PV Types: All

Target Audience: EDI Batch File Submitters
HP Enterprise Services will host a 5010 conference call on Friday, October 21st from 1:30-2:30PM central time. 

The following topics will be discussed:

  • 5010 testing update
  • SoonerCare specific changes for 5010 (CN1)
  • New Transactions
  • 5010 Testing Request Form
  • Announcement of NCPDP D.0 “go live” date
  • Questions/Answers

All SoonerCare EDI submitters, billing agents, clearinghouses, VANS, and software vendors are welcome to attend this teleconference. Please contact the EDI Helpdesk with any questions at (405) 522-0114, option 2, 2.

Date:  Friday October 21, 2011
Time: 1:30-2:30PM central time. 
Conference dial in number:  866-409-2889
Conference Code: 4931653160

10/13/2011 Customer Data Core (CDC) Training

Title: Customer Data Core (CDC) Training

Run Date: 10/13/2011 – 11/01/2011

PV Type:  53 - LBHPs

Customer Data Core (CDC) Training
The purpose of this training is to help understand how to report data for the ODMHSAS/OHCA Customer Data Core (CDC; see links below). The training will hosted by Dr. Mark A. Reynolds, a 19-year employee of ODMHSAS.

The trainings will be split into different groups. Two trainings will focus on the CDC and how it pertains to individually-contracted LBHPs and the other two will be focused on the CDC and how that affects outpatient agencies.

This is an OPTIONAL training and is focused on the data elements. This training will NOT be covering data entry in ProviderConnect. It is strongly recommended that each attendee log in 10-15 minutes prior to the start of the webinar. Thank you and hope to see you there.

CDC Training for Individually-contracted LBHPs (not working at outpatient agencies)
                Tue, Oct 18, 2011 9:00 AM - 10:00 AM CDT
                Mon, Oct 24, 2011 2:00 PM - 3:00 PM CDT
CDC Manual:
                www.odmhsas.org/CDCManualFY12.pdf
CDC Form:
                www.odmhsas.org/CDCFormFY1220110825.pdf

10/11/2011 Updated CPT-HCPCS Codes

Title:  Updated CPT-HCPCS Codes

Run Date: 10/10/2011 – 11/25/2011

PV Types: 

  • 01 – Hospitals
  • 02 – Ambulatory Surg Ctr
  • 08 – Clinics
  • 31 – Physicians
  • 52 – State Employed Physicians

In excess of 185 CPT/HCPCS codes failed to update in the July 1, 2011 Physician Fee Schedule (PFS) update. These codes were updated by 9/1/2011. 

All claims with a date of service after 06/30/2011 that were processed between 07/01/2011 and 08/31/2011 which contain affected codes will be reprocessed.  The reprocessed claims will appear on provider remits 10/26/2011 and the ICN will begin with “5211286”. 

Reprocessing will result in either a slightly higher or a slightly lower payment. The change in payment should not be significant. 

10/7/2011 General Info to BH Providers re: OPTUM, etc

Title:  General Info to BH Providers re: OPTUM, etc

Run Date: 10/07/2011 – 11/22/2011

PV Types: 

  • 11  – Mental Health Provider
  • 011 - Psychiatric 
  • 110 – Outpatient Mental Health Clinic
  • 111 – Community Mental Health Center (CMHC)
  • 112 - Psychologist
  • 118 – Mental Health/DMHSAS
  • 535 - Licensed Mental Health Professional (LBP)
  • 45  - Residential Behavior Management
  • 53  - Licensed BH Practioner
  • 533 – Behavioral Health Rehab Spc
  • 535 Licensed Mental Health Professional - LBPs

As part of the OHCA commitment to our Behavioral Health provider community we want to assist you in a timely manner when you have questions. Please note the following contact information.

OPTUM Health is our new Prior Authorizations (PA) vendor. Please continue to contact them for PA submissions and subsequent follow-up at: 2401 NW 23rd Street Suite 1B, OKC, OK 73107; phone (800)854-0833; FAX (855)543-5921; or their website at www.optumhealthoklahoma.com.

For all other inquiries please call the OHCA Call Center at (800)522-0114 or locally (405)522-6205. ‘Option 1’ will assist you with claims, policy, and general questions about the agency. ‘Option 5’ will connect you with an experienced provider enrollment staff member to assist with your contract questions.

With recent changes in Behavioral Health staff we wanted to remind you that OHCA has many OHCA staff able to assist you in a timely manner. Thank you for your continued support of our SoonerCare members.

10/4/2011 Speech Therapy re: More than one CPT code

Title: Speech Therapy re: More than one CPT code

Run Date: 10/04/2011 – 11/19/2011

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

When requesting approval for more than one CPT code, you must identify which goal (s) will be addressed for each CPT code. This helps the consultant evaluate appropriateness of the units requested for each service. 

When responding to a request for additional information, please initial and date any revisions.  Also, initial any corrections made to the forms.  This will help the reviewer identify the new information.

10/4/2011 IFMC Name Change [To Telligen]

TITLE:  IFMC Name Change [To Telligen]

Run Date: 10/04/2011 – 11/19/2011

PV Types: All

OHCA has worked with IFMC since February 2008 with the launch of the SoonerCare Health Management Program. OHCA’s relationship with IFMC expanded when they took over responsibility for External Quality Review functions on July 1, 2011.  They continue to support both programs and have been an important partner of the Health Care Authority.

IFMC recently announced a change in their corporate identity which included a new corporate name.  Their new name is Telligen.  This change is effective immediately. 

Although the name has changed, all other aspects of program operations will remain the same.  Telligen will continue to operate from the same office in Oklahoma City with the same mailing address and phone numbers. 

The only other change is the email address for Telligen staff.  The new domain name is Telligen.org (replacing IFMC.org).

9/20/2011 2011 CPT codes for Pelvic & Abdominal Tomographies

Title: 2011 CPT codes for Pelvic & Abdominal Tomographies

Run Date: 09/19/2011 – 12/19/2011

PV Types: 341 – Radiologist

2011 CPT has combined the codes for pelvic and abdominal tomographies into three new codes, 74176, 74177, and 74178.   The old codes for the abdomen and the pelvis still exist, but when the two services are performed together the new codes should be billed.  Our system is automatically rebundling your 2010 claims with the old codes and paying for the combined service.   We have initiated a protocol to process these 2010 service dates and pay them as they would have been reimbursed prior to 2011.  

Please resubmit all 2010 claims that have been denied or paid incorrectly for reprocessing.   Claims for service dates after 1/1/2011 should be billed using the new codes when these services are combined.

Beginning Monday, 09/15/2011, you will have 90 business days to resubmit these claims. After that we will need to change the system back to support 2011 CPT code claims criteria.

9/12/2011 Outpatient Behavioral Health Agency Providers: Individual Rendering Provider Enrollment Information

TITLE: Outpatient Behavioral Health Agency Providers: Individual Rendering Provider Enrollment Information

Run Date: 09/12/2011 – 10/23/2011

PV Types: 110 – Outpatient Mental Health Clinic
          111 – Community Mental Health Center (CMHC)
          118 – Mental Health – DMHSAS
          114 - PACT
         
This communication only applies to OPBH agency providers:

  • Very important:  Make sure you fax all of the required documents when you complete the electronic provider enrollment form.  The provider enrollment department processes the application based on receipt of the required fax.
  • The individual staff have to sign the provider agreement.  There is no exception to the staff signature requirement.
  • Under Supervision for Licensure:
    • License Number: TEMP
    • Original Issue Date:  List the start date of the board approved supervision agreement.
    • Expiration Date:  The estimated end date for the supervision.
    • Required Document to Fax: The licensure department’s approved supervision agreement.
9/12/2011 Fluoride Varnish

Title: Fluoride Varnish

Run Date: 09/12/2011 – 10/23/2011

PV Types: All

Attention Medical Home Providers: 

This is a reminder that Primary Care Providers may be reimbursed for the application of fluoride varnish beginning 7-1-2011. Please see OHCA 2011-32 for specifics! 

OHCA wishes to clarify some confusion regarding the training required to provide and be reimbursed for this procedure.  Online required training is available at www.aap.org/oralhealth (Smiles for Life National Oral Health Curriculum).  Two sessions are required:  1) Child Oral Health Assessment &,  2) Fluoride Varnish. 

If your office has submitted certificates for other curriculums this could prevent us from certifying you and could affect payment. 

Thank you for your cooperation.

9/12/2011 Provider Letter 2011-40 Re: Hydroxyprogesterone Injections

Title: Provider Letter 2011-40 Re: Hydroxyprogesterone Injections

Run Date: 09/12/2011-10/27/2011

PV Types: All

The effective date for Provider Letter 2011-40, re: Hydroxyprogesterone injections prior authorization requirement, is 09/15/2011.

If you have denied claims for dates of service prior to 09/15/2011, please refile your claims.

9/8/2011 Reminder: 2011 Fall Training Registration

Title: Reminder: 2011 Fall Training Registration

PV:  All

Run Date: 09/08/2011 – 10/31/2011

Registration for the Durant Fall Workshop [scheduled for September 14th, 2011] closed effective 09/07/2011. Walk-in registration will be allowed at this location beginning at 8:00 a.m. on September 14th. Workshops will begin at 8:30 a.m.

Lawton, OKC and Tulsa registration remains open at this time. Register today!

We look forward to seeing you this Fall!

8/31/2011 2011 Fall Provider Workshop Training

Title: 2011 Fall Provider Workshop Training

Run Date: 08/31/2011 – 10/25/2011

PV Types: All

PLEASE JOIN US FOR THE 2011 FALL PROVIDER WORKSHOP!
By attending, you and your office will receive invaluable information on SoonerCare policies, programs, utilization tips and recent changes. Specific classes include HIPAA Version 5010 for SoonerCare, a general overview of Prior Authorization Submissions, a Provider’s Guide to Care Management Services and Medical Home Audit Process, just to name a few!
Register today!
Information and registration is available at: 
http://www.okhca.org/xTraining.aspx 

Durant, OK will be the first stop on September 14th followed by: Lawton, September 29th; Tulsa, October 11th – 12th; and, conclude in Oklahoma City, October 26th – 27th.

8/31/2011 WEBINAR: Rendering Provider ID/Master PA

Title: WEBINAR: Rendering Provider ID/Master PA

Run Date: 08/29/2011 – 09/27/2011

PV Types: 110 – Outpatient Mental Health Clinic
  111 – Community Mental Health Center (CMHC)
  118 – Mental Health – DMHSAS
  114 - PACT
  

Outpatient Behavioral Health Contracted Agencies:

Webinar trainings will be hosted by the OHCA and will review two major changes for OPBH contracted agencies:  rendering requirement on the claim, and, the assignment of a Master PA ID for the agency. These changes will be implemented on October 1, 2011 and apply only to OPBH agencies. This training does not pertain to private practitioners, LBHPs or psychologists.

The first change is the requirement to enroll the OPBH agency individual rendering staff with OHCA. Effective 10/01/2011, the individual rendering provider number will be required on all OPBH claims.  The second change is the assignment of the Agency Master PA ID for OPBH agencies.

It is important for all individuals who provide services within a behavioral health outpatient agency and any person responsible for billing at your OPBH agency to attend this training. There are a limited number of spaces available for the webinars.

Register for one of the webinars now by using the internet address listed below:

Wednesday, 09/07/2011, 9:00 – 10:00 a.m.:
https://www1.gotomeeting.com/register/778150713

Tuesday, 09/13/2011, 3:30 – 4:00 p.m.:
https://www1.gotomeeting.com/register/783242320

Monday, 09/26/2011, 10:00 – 11:00 a.m.:
https://www1.gotomeeting.com/register/366483072

8/22/2011 School-Based Training

Title:  School-Based Training

Run Dates: 08/22/2011 – 09/29/2011

PV Types:  12, 120 School Corp

School-Based Training is scheduled for the following dates:

September 19, 2011 – Poteau (1:00pm to 03:00pm)
September 22, 2011 – Stillwater (10:00am to 12:00pm)
September 28, 2011 – McAlester (10:00am to 12:00pm)
September 29th,2011– Oklahoma City (10:00am to 12:00pm)

Please register for the training through OHCA website at:

http://www.okhca.org/schoolbased

8/15/2011 Provider Services Telephone Number Change

Title: Provider Services Telephone Number Change

Run Date: 08/16/20111 – 10/01/2011

PV Types: All

Due to impending migration to a new telephone system, 1-877-823-4529 option 2 is no longer a valid option.

The elimination of this option was earlier than anticipated. We apologize for any inconvenience. 

Providers needing assistance should contact OHCA Call Center @ 1-800-522-0114 option 1.

8/12/2011 Vaccines for Dually Eligible Members

Title:  Vaccines for Dually Eligible Members

Run Date: 08/12/2011 – 09/27/2011

PV Types: All

Vaccines not covered by Medicare Part B are covered by Medicare Part D. There are two options for addressing this issue:  (1) the provider may write a prescription for the vaccine and the patient can bring it to the office for administration, or (2) the provider can have the patient pay for the vaccine and then the patient files a claim with their Medicare Part D plan for reimbursement. 

The administration fee of a Medicare Part D vaccine is not covered by Medicare Part B or Part D. SoonerCare does not cover the cost of a vaccine administration for adults past the age of 26. When the service is not compensable by any of these plans, the provider may bill the patient for the vaccine administration.

Dually eligible children through the age of 18 should continue to get vaccines through the Vaccine for Children (VFC) Program. The administration fee for these vaccines is covered by SoonerCare in the same way it is covered for Medicaid-only eligible children.

Before giving a vaccine to a dually eligible patient you should inform them of their financial responsibilities.

8/10/2011 5010 HIPAA Companion Documents

Title: 5010 HIPAA Companion Documents

Run Date: 08/10/2011 - 12/31/2011

PV Types: All

The 5010 HIPAA Companion Documents that will be implemented on 1/1/2012 are posted on the OHCA EDI page under resources:

http://okhca.org/providers.aspx?id=13062

You risk claim rejections and interrupted cash flow if your electronic claims are not submitted in this new format. Please contact your clearinghouses and billing agencies to make sure they are aware of this important change on 1/1/2012. 

We will also be having a 5010 compliance class in the upcoming fall workshops. Registration for the workshops will be posted to the site on August 18, 2011. 

8/1/2011 Focus on Excellence Contract

Title: Focus on Excellence Contract

Run Date: 08/01/2011 - 09/15/2011

PV Types: 03; spc 030, 035

The contract with My InnerView for the Focus on Excellence (FOE) has expired.  The Oklahoma Health Care Authority (OHCA) is in the process of writing an RFP to contract for these services.  The FOE program has not changed.  Information necessary for payment rates are already collected by MI for payments through December 31, 2011.  Payments continue to be calculated on data from the previous two quarters.  You will receive further information prior to January 1, 2012 on changes and data collection methodology.  The FOE Web site is currently housed at OHCA and is operational.  You may continue to update facility profiles in the same manner as before.  All questions concerning the FOE program should be directed to FOE staff.

7/26/2011 OHCA Provider Letter 2011-42

Title: OHCA Provider Letter 2011-42

To: All Providers

Run Date: 07/26/2011 – 09/16/2011

Please disregard OHCA Provider Letter 2011-42 as the information is incomplete. An updated letter will be issued at a later date.

Thank you for your continued support.

7/20/2011 School Based Billing Rates

Title: School Based Billing Rates

Run Date: 07/20/2011 – 09/05/2011

PV Types: 12; 120

Effective 7/1/2011 School-Based billing rates have changed.

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

7/20/2011 BPAP and CPAP Supply Utilization Changes

Title: BPAP and CPAP Supply Utilization Changes 

Run Dates: 07/20/2011 – 09/05//2011

PV Types: 250 – DME/Medical Supply Dealers

The following BPAP and CPAP Supply codes are currently set for utilization at 1 per year.  Effective August 1, 2011, the codes listed are eligible for additional units with Prior Authorization and medical necessity to support the additional units.  

A7027 – Combination oral/nasal mask used with CPAP
A7030 – Full Face Mask for CPAP;
A7031 – Face Mask interface replacement for FF Mask
A7032 – Cushions for CPAP Mask – replacement only
A7034 – Nasal Application Device (CPAP Mask)
A7037 – Tubing used with CPAP Mask

This change will allow for medically necessary supplies 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.

7/20/2011 Medicare/Medicaid Dual Eligibles

Title: Medicare/Medicaid Dual Eligibles

Run Date: 07/13/2011 – 09/05/2011

Pv Types: All

This is a reminder to all providers serving our dually eligible members (Medicare and Medicaid eligible).

When Medicare Part B does not cover a physician administered/outpatient drug, the drug then falls under the jurisdiction of Medicare Part D. This also applies to physician administered contraceptives. A Medicare Part D plan must cover at least 2 drugs in every drug category. Additional drugs may be available with prior authorization or by appeal.  Each Part D plan has a separate formulary and appeals process.

Medicaid will pay the co-insurance and deductible for the administration of the drug.

FYI: Part D formularies are available at www.epocrates.com.

7/20/2011 Behavioral Health ICD-9 Diagnoses Codes (Clarification)

Title:  Behavioral Health ICD-9 Diagnoses Codes (Clarification)

Run Date: 07/19/2011 – 09/05/2011

PV Types: 11 – Mental Health Provider

  53 – Licensed Beh Health Practioner
100 – Physician Asistant
110 – Outpatient Mental Health Clinic
111 – Community Health Center (CMHC)
112 – Psychologist
114 – Health Service Provider in Psychology (HSPP)
115 – Certified Clinical Social Worker
116 – Certified Social Worker
117 – Psychiatric Nurse
118 – Mental Health – DMHSAS
119 – Family Training
121 – Licensed Professional Counselor
122 –  Day Treatment
123 – Para Professional
160 – Registered Nurse (RN)
210 – Care Coordinator for Pregnant Women
211 – HIV Case Manager
221 – MH Case Mgmt Providers
339 – Psychiatrist
530 – Outpatient Substance Use
531 – CMHC Substance Use
532 – Substance Use - DMHSAS
533 – Behavioral Hlth Rehab Specialist (bachelor level)
534 – Alcohol and Other Drug Treatment Professional
535 – Licensed Mental Health Professional (LBP)
553 – Child Psychiatry
585 – Licensed Marital and Family Therapists
586 – Licensed Alcohol and Drug Counselor

REMINDER: Please DO NOT use decimal points with your ICD-9 Diagnoses Codes when submitting claims. As a general rule, using decimal points may result in your claim(s) being denied and payment(s) delayed.

Thank you.

7/15/2011 Voided Claim Error: Code 167

Title: Voided Claim Error: Code 167

Run Date: 07/15/2011 – 09/05/2011

PV Types: All

If you try to void/adjust a claim and receive an error: “Void may have failed. No response available. Code 167”, please wait and try to void/adjust the claim after July 30, 2011.

These claims are being processed as a mass adjustment that WILL NOT affect provider payments.

7/13/2011 PA Requirement for Panoramic Xrays

Title: PA Requirement for Panoramic Xrays

Run Date: 07/13/2011 – 08/31/2011

PV Types: 27;

Spc:  086, 271, 272, 273, 274

Prior Authorization is required for panoramic x-rays for members 0-5 years of age, effective 7-1-2011.

7/6/2011 Reminder to Watch for Updates #2

Title:  Reminder to Watch for Updates #2

Run Dates: 07/05/2011 – 08/20/2011

PV Types: All

Provider letters outlining information regarding recent changes in policy promulgated through the Administrative Procedures Act can be viewed on the OHCA public website at www.okhca.org/electronic-letters. These changes were heard and approved at the March 10, 2011 OHCA board meeting and were adopted by the legislature May 10, 2011

Please remember to check the OHCA Public Website (at the above listed website) to access important information which may have an impact on the services that you provide to Oklahoma’s SoonerCare and Insure Oklahoma members. 

If you have questions please contact the SoonerCare Provider Services Office at (877)823-4529 option 2. Thank you.

7/5/2011 Reminder to Watch for Updates

Title:  Reminder to Watch for Updates

Run Dates: 07/05/2011 – 08/20/2011

PV Types: All

Changes to provider letters that outline information regarding  changes in policy that have been promulgated through the Administrative Procedures Act were heard and approved at the March 10, 2011 OHCA board meeting and were  adopted by the legislature May 10, 2011

Please remember to check the OHCA Public Website at www.okhca.org/electronic-letters to access important information which may have an impact on the services that you provide to Oklahoma’s SoonerCare and Insure Oklahoma members. 

If you have questions please contact the SoonerCare Provider Services Office at (877)823-4529 option 2. Thank you.

7/5/2011 MUE Edited Codes Billed Over the Allowed Limit

Title: MUE Edited Codes Billed Over the Allowed Limit

Run Dates: 07/05/2011 – 08/20/2011

PV Types:  All

Procedures and services that are subject to Medically Unlikely Edits (MUE) may be allowed to exceed those limits if medical necessity is established for the additional units.  Documentation must be appended with the claim to support the additional services and the additional units must be billed on separate lines with the appropriate modifiers listed to show it is a repeated service.

6/25/2011 Annual Update to RBRVS Fee Schedule

Title: Annual Update to RBRVS Fee Schedule

Run Date: 06/20/2011 – 08/05/2011

PV Types: All

This is our annual reminder that we rebase our provider RBRVS 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 rate cut of 3.25% is still in effect.
If you have any questions please, contact provider services at 1-877-823-4529, option 2.

6/17/2011 Dental Documentation Materials

Title:  Dental Documentation Materials

Run Date: 06/15-2011 – 08/01/2011

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

MESSAGE:

Per policy, as of 7-1-2011, the OHCA Dental Unit will not return [to you] any documentation submitted pertaining to Dental Prior Authorizations. 

Please send diagnostic quality copies to ensure timely action.

Thank you for your continued participation in the SoonerCare Program.

6/17/2011 Mailing Address for Dental Prior Authorizations

Title: Mailing Address for Dental Prior Authorizations

Run Date: 06/15-2011 – 08/01/2011

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

MESSAGE:

Please send all Dental PA requests to:
                       
OHCA
ATTENTION: Dental Unit
2401 NW 23rd St., Suite 1-A
Oklahoma City, OK  73107

Please do not send any correspondence to our former physical address at Lincoln Plaza on Lincoln Blvd, OKC.

Thank you for your continued participation in the SoonerCare Program.

5/17/2011 2011 Tulsa Spring Provider Training

Title: 2011 Tulsa Spring Provider Training

Run Date: 05/16/2011 – 05/25/2011

PV Type:  All

Registration for the Tulsa Spring Provider Workshop will close at 5 p.m. on May 17th!  Walk-in registrations will be limited and on a first come, first serve basis on the day of the workshops. We look forward to seeing you there!
Go to http://www.okhca.org/xtraining.aspx to register.

5/16/2011 DME – Orthoses Not Otherwise Classified Codes – Prior Authorization Requirement

Title: DME – Orthoses Not Otherwise Classified Codes – Prior Authorization Requirement

Run Dates:  05/16/2011 – 06/30/2011

PV Type:    17-Therapists, 25 - DME
                
Effective May 1, 2011, the following orthosis codes require prior authorization.  Since these codes are in the “Not Otherwise Classified” category, please be aware that  various orthosis products  may fit under these codes that now require PA. 

As always, please use the most specific HCPCS code when billing.

These codes are to be used only in the event that there is no HCPCS code that describes the specific product:
L1499  Spinal orthosis, not otherwise specified;  
L2999  Lower extremity orthoses, not otherwise specified;
L3999  Upper limb orthosis, not otherwise specified

4/27/2011 2011 OKC Spring Provider Training

TITLE: 2011 OKC Spring Provider Training

Run Date: 04/27/2011-05/11/2011

Pv Types: All

Registration for the Oklahoma City spring provider workshop will close at 5pm on May 4th!  Registration for the Tulsa workshop remains available at this time. Walk-in registrations will be limited and on a first come, first serve basis on the day of the workshops. We look forward to seeing you there!

Go to http://www.okhca.org/xtraining.aspx to register.

4/5/2011 School Based Fee Schedule
Re: Procedure Code 97150

Title: School Based Fee Schedule
Re: Procedure Code 97150

Run Date: 04/05/2011 – 05/20/2011

PV Type: 12 / SPC 120

MESSAGE

Effective April 1, 2011: The School Based Fee Schedule has changed in reference to therapeutic group therapy procedure code 97150.  Providers will only be allowed to bill one daily unit.

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

4/4/2011 Reminder: Ada Spring Training

Title:  Reminder: Ada Spring Training

Run Date:  04/01/2011 – 04/14/2011

PV Types:  All

Registration for the Ada, Oklahoma Spring provider workshop will close at 5pm on April 6th!  Registration for the workshops in Oklahoma City and Tulsa locations remain available at this time. We look forward to seeing you there!

3/22/2011 Reminder to Check Public Website for Updates

Title: Reminder to Check Public Website for Updates

Run Date: 03/18/2011 – 05/22/2011

PV TYPES: All

Message:

A provider notification outlining the Oklahoma Health Care Authority’s plan to follow the Center for Medicare and Medicaid Services (CMS) in implementing the mandatory use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUE) for all 1500 and Outpatient SoonerCare claims can be viewed on the OHCA public website at www.okhca.org/electronic-letters.

Please remember to regularly check the OHCA Public Website (at the above listed website) to access important information which may have an impact on the services that you provide to Oklahoma’s SoonerCare and Insure Oklahoma members. 

If you have questions please contact the SoonerCare Provider Services Office at (877)823-4529 option 2. Thank you.

3/15/2011 New Speech Therapy PA Requirements

Title: New Speech Therapy PA Requirements

Run Date: 03/15/2011 – 04/30/2011

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

Effective 04/10/11, all requests for speech therapy services must include the following information in the evaluation report: 

1) the child's native language and the language in which the evaluation was conducted; 2) the location where the evaluation was conducted and the location where services will be provided; and, 3)the number of sessions attended during the previous authorization period for a child who has a history of services with the same provider.

3/11/2011 2011 Provider Spring Workshop

Title: 2011 Provider Spring Workshop

PV Type: All

Run Date: 03/10/2011 – 05/23/2011

PLEASE JOIN US FOR THE 2011 PROVIDER SPRING WORKSHOP!

Providers who attend will get beneficial information on SoonerCare policies and programs. Specific classes include Dental Prior Authorizations, the Affordable Care Act, Reading your Remittance Advice and an update on the Electronic Health Record (EHR) Incentive just to name a few!
Register today!
Information and registration is available at: 
http://www.okhca.org/provider-training 

Woodward, OK will be the first stop on April 7th followed by:
Ada, April 13th;
Oklahoma City, May 11th – 12th; and,
conclude in Tulsa, May 24th – 25th.

03/01/2011 School Based Training

Title: School Based Training

Run Date: 02/25/2011 – 04/01/2011

PF Type: Type 12 ; Specialty Type 120

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

March 22, 2011 – McAlester (10 a.m. to 12 p.m.)
March 23, 2011 – Poteau (1p.m. to 3 p.m.)
March 29, 2011-Stillwater (10 a.m. to 12 p.m.)
March 31, 2011-Oklahoma City (10 a.m. to 12 p.m.)

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

02/28/2011 GO GREEN OKLAHOMA Initiative update

Title: GO GREEN OKLAHOMA Initiative update

Run Date: 02/25/2011 – 04/10/2011

PV Types: All

The Oklahoma Health Care Authority recently notified all providers of our plans to “GO GREEN” effective February 1, 2011.

The “GO GREEN” initiative currently is for provider letters/notifications ONLY and does not include provider remittance statements. If you are currently receiving a paper remittance statement, it will continue in the paper format, at this time. 

02/14/2011 Den-3 Dental Provider Change Form

Title: Den-3 Dental Provider Change Form

Run Date: 02/11/2011 – 03/31/2011

PV Types: 27 – Dentist

Dental providers please note there is a revised DEN–3 Dental Provider Change Form on the public website.

We now request a contact person and phone number.

01/28/2011 Resources for access to Developmental/Behavioral
and Psychiatric Telephone Consultation Services

Title:  Resources for access to Developmental/Behavioral and Psychiatric Telephone Consultation Services

Run Date: 01/26/2011 – 03/15/2011

PV Types: 31- Physicians
  032 – Pediatric Nursing Facility
  088 – Pediatric Clinic
  090 – Pediatric Nurse Practitioner
  093 – Nurse Practitioner
  100 – Physician Assistant
  345 – General Pediatrician


Developmental/behavioral and Psychiatric telephone consultation services offer SoonerCare providers with resources and evidence-based practices to help maintain a high quality of care to pediatric patients aged 0-6. These phone services allow for access to the developmental/ behavioral pediatricians or nurse practitioners at the Child Study Center on the University of Oklahoma Health Sciences Center campus, and to board certified psychiatrists at APS Healthcare, Inc.

These resources were designed to broaden the provider’s knowledge of developmental/behavioral/psychiatric health conditions and to offer guidance on primary care management of children with conditions such as neurodevelopmental disorders, ADHD, autism, and learning and/or intellectual disabilities. Consultations can include questions regarding best practices in developmental/behavioral/psychiatric care, strategies for medication management, recommendations for services and resources, and other issues as needed.

Developmental/behavioral service contact is Peggy Yen, RN, ARNP by calling (405) 271-5700 ext. 39230 or (800) 271-2717 or email peggy-yen@ouhsc.edu. Office hours are Monday through Friday 8:30 a.m. to 5:00 p.m. If calling outside the office hours, leave a message and your call will be returned within 24 hours. Please visit their website at www.oumedicine.com/consultservices.
 
Psychiatric consultation contact is 1.877.845.7468.

01/27/2011 GO GREEN OKLAHOMA Initiative update

Title:  GO GREEN OKLAHOMA Initiative update

Run Date: 01/26/2011 – 03/15/2011

PV Types: All

The Oklahoma Health Care Authority recently notified all providers of our plans to “GO GREEN” effective February 1, 2011.

If you have questions regarding this transition please refer to the previous notices dated 11/15/2010 and 12/06/2010 regarding the GO GREEN OKLAHOMA INITIATIVE; or, if you have any questions or concerns please contact the SoonerCare Provider Services office at (877)823-4529, option 2.

01/25/2011 REMINDER: DMEPOS Contracts Expire 01/31/2011

Title: REMINDER: DMEPOS Contracts Expire 01/31/2011

Run Date: 01/25/2011 – 03/31/2011

PV:   24/240 – Phamacies 25/250 DME/Medical Equipment Supplier

All current contracts for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) expire January 31, 2011. A letter explaining the process has been posted to the DME website for your use.  http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669.

REMINDER, you must include a copy of your Accreditation Certificate or an Exemption letter from OHCA with your re-enrollment – see FAX instructions at the re-enrollment site.

Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org or Provider Enrollment at 1.800.522.0114 Option 5.
You may disregard this message if your organization has completed the re-enrollment process for re-enrollment through January 31, 2014.

01/14/2011 Incorrect ASC/APC Payment Rates

Title: Incorrect ASC/APC Payment Rates

Run Dates: 01/13/2011 – 03/01/2011

PV Types: 01 – Hospital ,02 - ASC

Hospital & Ambulatory Surgery Center Administrators: Outpatient Claims Processing
OHCA rebased the APC & ASC payment rates to Medicare effective January 1, 2011. These new rates were not reduced by 3.25% to reflect the budget reduction that is currently in place. The system has been updated with the correct rates. OHCA will reprocess all outpatient hospital and ambulatory surgery claims for services provided between January 1 and January 12, 2011 and paid prior to January 19, 2011. The reprocessed claims will be on providers January 26th remit.  The new ASC / APC fee schedules can be found on our public website.

We apologize for any inconvenience. 

01/10/2011 Group Contracts Expired 11/30/2010

Title: Group Contracts Expired 11/30/2010
Run Date: 01/06/2011 – 01/31/2011
PV:   08; 082

All Group contracts expired November 30, 2010. 

If you have not submitted your Renewal Contract to the OHCA, you may access the Secure website location from the OHCA website www.okhca.org.  Go to Providers, Enrollment, Renewal Contracts and click on “Continue to the secure site for Online Enrollment.” Once you have completed the renewal contract, you must fax in the required documents.  Print the fax cover sheet, and fax to the number listed. 
REMINDER: After January 29, 2011, the “Renewal Contract” will no longer be accessible through Electronic Provider Enrollment (EPE) for Groups. 

Providers must complete a “New Contract” to re-enroll. 

Please direct all inquiries to Provider Contracting at 1-800-522-0114, Option 5.
You may disregard this message if your clinic has completed the re-enrollment process for the current re-enrollment period. 

01/10/2011 DMEPOS Contracts Expire 01/31/2011

Title: DMEPOS Contracts Expire 01/31/2011

Run Date: 01/06/2011 – 01/31/2011

PV: 24 – Phamacies, 25 DME/Medical Equipment Supplier

All current contracts for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) expire January 31, 2011.  Letters explaining the process were sent to you in 2010.  You may access your Secure website location under the MAIN tab and initiate the electronic re-enrollment process.

REMINDER, you must include a copy of your Accreditation Certificate or an Exemption letter from OHCA with your re-enrollment – see FAX instructions at the re-enrollment site.
Please direct inquiries to Stan Ruffner – Director – DME Program at stan.ruffner@okhca.org or Provider Enrollment at 1.800.522.0114 Option 5.

You may disregard this message if your organization has completed the re-enrollment process for re-enrollment through January 31, 2014.