2012 Global Messages

Posted
Date

Subject

Message

12/27/2012 Change to Call Center Operations

Title: Change to Call Center Operations

Run Date: 12/21/2012 – 02/10/2013

PV Types: All

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

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

This transition does not affect the Pharmacy Help Desk calls.

12/13/2012 Behavioral Health PA Training

Title: Behavioral Health PA Training

Run Date: 12/13/2012 – 02/01/2013

PV Type:  11, 53

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

Dear Outpatient Behavioral Health Provider,
The process for prior authorization for outpatient behavioral health services will restart on 1/15/2013. Working with OHCA, this process will be handled by ODMHSAS in PICIS and will be done by adding a few data elements to the CDC. For members active prior to 1/15/2013, ODMHSAS will create authorizations based on existing CDC information. ODMHSAS will have a large number of webinar trainings available. During those trainings, you will be shown the additional information required, the process to follow and be provided an explanation of how authorizations were created for existing customers. To register for the trainings, please go to 
http://www.odmhsas.org/arc.htm. The webinar trainings are rapidly filling up. Please enroll today to ensure your preference

12/5/2012 RETRACTION - Diabetic Strips & Lancets for Gestational Diabetes

Title: RETRACTION - Diabetic Strips & Lancets for Gestational Diabetes

Run Date: 12/05/2012 – 03/31/2013

PV Types: DME Providers - 25; Physicians - 31

Message: RETRACTION to Global Message dated 09/24/2012 re: Diabetic Strips & Lancets for Gestational Diabetes

OHCA Policy does not allow for exceptions for additional supplies without prior authorization for specific diagnosis codes. 
Consistent with policy 317:30-5-211.15;  effective immediately only 2 boxes of diabetic strips (100 units) and 1 box of lancets (100 units) will be allowed per month without prior authorization.  Diabetic supplies in excess of these limits must be prior authorized.
For all PA-related questions, please call the Call Tree at (800)522-0114.

11/30/2012 Service Code H2017 After consulting with providers, infant mental health experts, and the Department of Mental Health and Substance Abuse (ODMHSAS) regarding the service code H2017 (psychosocial rehabilitation services – per 15 minutes), OHCA in consultation with ODMHSAS has decided to deny all claims with dates of service on or after 12-01-2012, submitted for H2017 for children aged 0-3 years old. Those who reviewed the use of H2017 agree that the medical necessity criteria cannot be met for members within that age range. Questions may be directed to Provider Services at 1-800-522-0114
11/29/2012 Adjustments/TPL Webinar

Title:  Adjustments/TPL Webinar

Run Dates: 11/29/2012 – 12/12/2012

PV Types:  All

PLEASE JOIN US FOR THE ADJUSTMENTS/TPL WEBINAR ON December 13, 2012!

OHCA and HPES will host a webinar/conference call for all providers to review the correct process for submission of Adjustments and Third Party Liability (TPL) claims. The webinar/conference call will give detailed instructions and insight for these transactions on the secure site for SoonerCare providers.

The webinar will take place via online virtual room and conference call on December 13th at 2:30 pm. Registration is limited, so register today!

11/2/2012 Behavioral Health PA Restart

Title: Behavioral Health PA Restart

Run Date: 11/02/2012 – 01/30/2013

PV Type: 11, 53

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

Dear Outpatient Behavioral Health Provider,

The process for prior authorization for outpatient behavioral health services will restart on 1/15/2013. Working with OHCA, this process will be handled by ODMHSAS in PICIS and will be done by adding a few data elements to the CDC. For customers active prior to 1/15/2013, ODMHSAS will create authorizations based on existing CDC information. We will have a large number of webinar trainings over the coming months. During those trainings, we will be able to show you the additional information required, the process to follow and explain how authorizations were created for existing customers.

For those providers who have data systems which send CDC data to PICIS, we have begun working with your vendors. We are pleased with their willingness to work with us through these changes.

We hope your experience with PICIS provides you with the confidence that we will do everything possible to ensure authorizations are created timely, so that there will be no lapse in payment. We would also like to thank OHCA staff who have been very generous with their time and expertise.

If you would like to receive email updates about changes in PICIS, please go to http://www.odmhsas.org/updates.asp to subscribe.

Respectfully,

Mark A. Reynolds, Ed.D.
Director of Decision Support
Oklahoma Department of Mental Health and Substance Abuse Services
mareynolds@odmhsas.org

10/24/2012 X-rays Submitted for Dental PAs

Title: X-rays Submitted for Dental PAs

Run Date: 10/24/2012 – 12/14/2012

PV Types: Dental – 27

Spc: 086 - Dental Clinic
  271 – General Dentistry Practitioner
  274 – Pediatric Dentist 
  278 – General Dentist with Ortho Privilege

1. Only original film has an orientation dimple; therefore any print must identify a tooth of interest number or indicate which side of mouth is captured [L for left side, R for right side]. Please do not mark on teeth. This applies to any digital or film print that does not have the dimple for orientation.  Any copies submitted that do not meet the above criteria cannot be reviewed. Please review policy 317:30-5-698(d).

10/22/2012 Enteral Food Prior Authorization Timespan Changes

Title: Enteral Food Prior Authorization Timespan Changes

Run Dates: 10/22/2012 – 12/31/2012

PV Types: 250 – DME/Medical Supply Dealers

Effective January 1, 2013, the MAU staff will begin approving Enteral prior authorization requests (PARs) for a maximum timespan of 6 months.  In the past, we approved the PARs for up to 1 year.  However, due to the changing needs of the member, many times the requests had to be terminated so a new request could be entered for the member.  Therefore, we believe it will be beneficial to the staff reviewing / modifying these requests, as well as the member, to shorten the timespan to 6 months.  Thank you for your understanding and cooperation in this matter.

10/22/2012 Deadline for Enteral Food Prior Authorization Revisions due to Pricing Methodology Change 10/31/12

TITLE:  Deadline for Enteral Food Prior Authorization Revisions due to Pricing Methodology Change 10/31/12

Run Date: 10/12/12 – 10/31/12

PV TYPES: 250- DMEPOS Suppliers

The original notice of the changes to pricing and instructions for obtaining a revised PA was sent on 7/18/12.  The deadline for this option is October 31, 2012.  Providers must submit the documentation necessary to the fax # listed below to have the prior authorization revised.

Excerpt from Global Message sent 7/18/12

The following codes were changed from Max fee to Manual Pricing to align with PDAC: B4157 – B4158 – B4159 – B4160 – B4161 – B4162.

Effective immediately all requests for codes listed above must contain number of calories per can/packet, an invoice stating if priced per can/packet or case. If priced by case, state number of cans/packet per case.

If you have Prior Authorizations that span service dates after 7/1/12, please send a list including Member ID, Prior Authorization number, number of units to be billed after 7/1/2012, a copy of your invoice and the information listed above regarding invoice information and caloric information so that OHCA can adjust the Prior Authorization appropriately.

Please fax the detailed lists to 405-530-3261. Lists submitted to any other fax number will not be processed. This is a temporary number established for this purpose only and may not be used for any other Prior Authorization requests.

10/18/2012 Reminder: Cost Reports Due for SFY12

Title: Reminder: Cost Reports Due for SFY12

Run Date: 10/17/2012 – 11/01/2012

PV Types: 03 & Spc 030 (NF)

Attention: All Long Term Care Facility Providers - Cost Reports for SFY12 are due by October 31, 2012.  According to the approved State Plan, facilities late in filing Cost Reports may lose the direct care component of their rate.  Full year reports are required to be filed on the secure website and partial year reports are required to be filed on the form available on the OHCA public website (www.okhca.org). 

10/17/2012 Reminder: 2012 Fall Training Registration

Title: Reminder: 2012 Fall Training Registration

PV Types: All

Run Date: 10/17/2012 – 10/23/2012

Registration for the Oklahoma City Fall Workshop [scheduled for October 24-25, 2012] will close at 5:00 PM effective 10/17/2012. Walk-in registration will be allowed at this location beginning at 8:00 a.m. on October 24th & 25th. Workshops will begin at 8:30 a.m.

Information and registration is available at: http://www.okhca.org/xTraining.aspx

We look forward to seeing you this Fall!

10/10/2012 Adjustments/TPL Webinar

TITLE: Adjustments/TPL Webinar

RUN DATE: 10/10/12-10/15/12

PF TYPE: All Provider Types

PLEASE JOIN US FOR THE ADJUSTMENTS/TPL WEBINAR ON OCTOBER 17TH!

OHCA and HPES will host a webinar/conference call for all providers to review the correct process for submission of Adjustments and Third Party Liability (TPL) claims. The webinar/conference call will give detailed instructions and insight for these transactions on the secure site for SoonerCare providers.
The webinar will take place via online virtual room and conference call on October 17th at 2:30pm. Please register to take part.

Register today!

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

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

9/24/2012 Diabetic Strips & Lancets for Gestational Diabetes

Title: Diabetic Strips & Lancets for Gestational Diabetes

Run Date:  09/21/2012 – 11/05/2012

PV Types:  DME Providers - 25; Physicians - 31

Message:
Effective September 1, 2012, TXIX members with a diagnosis of gestational diabetes (Dx codes: 648.00, 648.03, 648.80 or 648.83) will be allowed one (1) additional vial of diabetic strips and one (1) additional box of lancets per month without a prior authorization (PA). This should allow sufficient supplies for testing four (4) times per day. 

For all PA-related questions, please call the Call Tree at (800)522-0114.

9/12/2012 2012 Fall Training Registration

Title: Reminder: 2012 Fall Training Registration

PV: All

Run Date:  09/11/2012 – 09/21/2012

Registration for the Lawton Fall Workshop [scheduled for September 20, 2012] will close at 5:00 PM effective 09/13/2012. Walk-in registration will be allowed at this location beginning at 8:00 a.m. on September 20th. Workshops will begin at 8:30 a.m.

Tulsa and OKC registration remains open at this time.  Information and registration is available at:   http://www.okhca.org/xTraining.aspx

We look forward to seeing you this Fall!

9/6/2012 Reminder: 2012 Fall Training Registration

Title: Reminder: 2012 Fall Training Registration

Run Dates: 09/06/2012 – 09/14/2012

PV Types: All

Registration for the Durant Fall Workshop [scheduled for September 13, 2012] will close at 5:00 PM effective 09/06/2012. We encourage you to register today!
Walk-in registration will be allowed at this location beginning at 8:00 a.m. on September 13th. Workshops will begin at 8:30 a.m.

Lawton, Tulsa and OKC registration remains open at this time.  Information and registration is available at:   http://www.okhca.org/xTraining.aspx

We look forward to seeing you this Fall!

8/29/2012 Webinar: NODOS/NB1

Title: Webinar: NODOS/NB1

Run Date: 08/29/2012 – 09/17/2012

PV TYPE: 01 – Hospitals

PLEASE JOIN US FOR THE NODOS/NB1 WEBINAR ON SEPTEMBER 18TH!

OHCA and HPES will host an important Webinar/Conference call for hospitals and birthing centers to review the correct submission process of Notification of Date of Service (NODOS) and the Newborn application, NB1.

The Webinar/Conference call will give detailed instructions and insight for these transactions on the secure site for both SoonerCare and potential SoonerCare members.

The webinar will take place via online virtual room and conference call on September 18th at 2:30. Please register to take part. Register today!

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

8/27/2012 School Based Training Schedule

Title: School Based Training Schedule

Run Dates: 08/27/2012 – 10/24/2012

PV Types: 12 / Spc 120

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

September 10, 2012 – Poteau (1:00pm - 03:00pm)
September 11, 2012 – Stillwater (10:00am - 12:00pm)
October 2, 2012– Oklahoma City (10:00am - 12:00pm)
October 23, 2012– McAlester (10:00am - 12:00pm)

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

8/27/2012 2 Fall Provider Training Workshop

Title: 2012 Fall Provider Training Workshop

Run Date: 08/24/2012 – 10/25/2012

PV Types: All

PLEASE JOIN US FOR THE 2012 FALL PROVIDER TRAINING WORKSHOP!
Providers who attend will get beneficial information on SoonerCare policies and programs. Specific classes include Claims Denials, Transition to ICD-10 and Med Solutions, just to name a few!
Register today!
Information and registration is available at: 
http://www.okhca.org/xTraining.aspx 
http://www.okhca.org/xCourses.aspx

Durant, OK will be the first stop on September 13 followed by: Lawton, September 20; Tulsa, October 10–11; and, conclude in Oklahoma City, October 24–25.

8/13/2012 Therapeutic Foster Care Changes to the Inspection of Care Audit Processes

Title:  Therapeutic Foster Care Changes to the Inspection of Care Audit Processes

Run Dates: 07/30/2012 – 09/30/2012

PV Types: 45 – Foster Care Agency 451 – RBMS Therapeutic Foster Care

This notification serves to clarify the policy requirements for the Inspection of Care (IOC) audit processes for Therapeutic Foster Care agencies.  In accordance with 317.30-5-743.1, policy requires a recoupment of the compensation received for a service when an audit deficiency is found.  The related Oklahoma Administrative Code states: “Deficiencies found during the IOC may result in a recoupment of the compensation received for that service. The individual plan of care is considered to be critical to the integrity of care and treatment and must be completed within the time lines designated at OAC 317:30-5-742.2. If the individual plan of care is missing or it is found that the child did not meet medical necessity criteria at any time, all paid services will be recouped for each day the individual plan of care was missing from the date the plan of care was due for completion.” In the last state fiscal year, the IOC auditors utilized a recoupment system that was based on the bundled payment methodology: Partial recoupments of $10 for each identified audit deficiency.  Since the payment method has changed from a bundled to a fee for service compensation, the previous recoupment system is no longer applicable. In compliance with the OAC, the fee for service recoupment process specified in the OAC will be utilized for the 2012-2013 inspections of care audits. We wish to thank you for your continued support and the services you provide SoonerCare members. If you have any questions or need additional information, please contact Provider Services at (800) 522-0114 or (405) 522-6205.

7/18/2012 Pricing Changes for Enteral Food HCPCS Codes

Title:  Pricing Changes for Enteral Food HCPCS Codes

Run Dates: 07/18/2012-09/30/2012

PV Types: 250 – DMEPOS Suppliers

Effective July 1, 2012, for TXIX members only, OHCA aligned Enteral Food products with the CMS fee schedule and PDAC coding.  The following codes are affected by these changes: B4155 – From $ 1.11 to $.91 – CMS Allowable is $ .94 minus 3.25% budget reduction.

The following codes were changed from Max fee to Manual Pricing to align with PDAC: B4157 – B4158 – B4159 – B4160 – B4161 – B4162.

Effective immediately all requests for codes listed above must contain number of calories per can/packet, an invoice stating if priced per can/packet or case. If priced by case, state number of cans/packet per case.

If you have Prior Authorizations that span service dates after 7/1/12, please send a list including Member ID, Prior Authorization number, number of units to be billed after 7/1/2012, a copy of your invoice and the information listed above regarding invoice information and caloric information so that OHCA can adjust the Prior Authorization appropriately.

Please fax the detailed lists to 405-530-3261. Lists submitted to any other fax number will not be processed. This is a temporary number established for this purpose only and may not be used for any other Prior Authorization requests.

7/18/2012 ICD-10 Provider Conversion Assessment Survey

Title:  ICD-10 Provider Conversion Assessment Survey

Run Dates: 07/16/2012 – 08/18/2012

PV Types: All

OHCA would appreciate your input on an ICD-10 Provider Conversion Assessment survey.  This survey will provide us with insight to better plan the ICD-10 implementation and develop helpful workshops that can be offered in support of the ICD-10 effort.  Please locate the survey on the Provider web site and respond soon.

7/13/2012 Frequently Asked Questions – OKDMERP

Title:  Frequently Asked Questions – OKDMERP

Run Dates: 07/12/2012 – 09/30/2012

PV Types: 250- DMEPOS Suppliers

The OKDMERP (Oklahoma Durable Medical Equipment Reuse Program) is attempting to assist OHCA providers regarding frequently asked questions regarding the process for donation and reassignment for medical equipment for the reuse program.
Please assist us by sending your questions via email to Stan Ruffner – DME Director at either
 stan.ruffner@okhca.org or fax to 405.530.3326. 

The FAQ and answers will be posted to the DME web page located at http://www.okhca.org/providers.aspx?id=594&menu=74&parts=7669 for your future reference.

6/11/2012 Annual Update to RBRVS Fee Schedule

Title: Annual Update to RBRVS Fee Schedule

Run Date: 06/11/2012 – 08/01/2012

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 (800)522-0114 option 1.

6/11/2012 EHR Attestations During Contract Renewal Period

Title: EHR Attestations During Contract Renewal Period

Run Date: 06/05/2012 – 07/20/2012

PV Types: 31, 52

Due to a system limitation, EHR Attestations cannot be submitted until contract renewals are submitted and processed. If you would like to submit an attestation for the EHR Incentive Program, please submit your contract renewal as soon as possible. We apologize for any inconvenience this will cause.

5/29/2012 Correction to Provider Letter 2012-27

Title: Correction to Provider Letter 2012-27

Run Date: 05/29/2012 – 07/15/2012

PV Types: 03; SPC 30, 35 (Nursing Facilities)

NURSING FACILITY PROVIDERS: Please note that Provider Letter OHCA 2012-27 [dated May 22, 2012] has an erroneous date of implementation of January 1, 2012 in the third paragraph.

The correct date of implementation is July 1, 2012.

5/15/2012 Registration for 2012 Tulsa Spring Training

Title:  Registration for 2012 Tulsa Spring Training

Run Date: 05/15/2012 – 05/24/2012

PV Type: All

Registration for the Tulsa Spring Workshop [scheduled for May 22 & 23, 2012 at the OSU - Tulsa Conference Center, 700 N. Greenwood Ave., Tulsa, OK 74106] will close at 5:00 PM effective 05/15/2012. This is the last workshop for the spring so don’t miss out! You can still attend through a walk-in registration. Walk-in registration will be allowed (with your provider number)at this location beginning at 8:00 a.m. on May 22th and 23rd. Workshops will begin at 8:30 a.m. Please come at least 15-20 minutes before the first class you wish to attend. 

Information and registration is available at:   http://www.okhca.org/xTraining.aspx

We look forward to seeing you!

5/15/2012 Latest Policy Changes/Updated Links for Inpatient & Outpatient Providers

Title: Latest Policy Changes/Updated Links for Inpatient & Outpatient Providers

Run Date: 05/15/2012 – 06/30/2012

PV Types: 01, 11, 53

Spc:  010, 011, 013, 015, 110, 112, 121, 585, 115, 535,
 536

Several revisions to the existing behavioral health policy were promulgated and went into effect on 3/7/12.  OHCA Medicaid Rules Page: http://okhca.org/xPolicy.aspx?id=734. Listed below are links to the policy for different provider types:

Part 6 – INPATIENT PSYCHIATRIC HOSPITALS: http://www.okhca.org/xPolicyPart.aspx?id=547&chapter=30&subchapter=5&part=6&title=INPATIENT%20PSYCHIATRIC%20HOSPITALS

Part 21 – OUTPATIENT BEHAVIORAL HEALTH SERVICES (ALL SECTIONS):  http://www.okhca.org/xPolicyPart.aspx?id=562&chapter=30&subchapter=5&part=21&title=OUTPATIENT%20BEHAVIORAL%20HEALTH%20SERVICES

Part 25 – PSYCHOLOGISTS: http://www.okhca.org/xPolicyPart.aspx?id=564&chapter=30&subchapter=5&part=25&title=PSYCHOLOGISTS

Part 26 – LICENSED BEHAVIORAL HEALTH PROVIDERS: http://www.okhca.org/xPolicyPart.aspx?id=655&chapter=30&subchapter=5&part=26&title=LICENSED%20BEHAVIORAL%20HEALTH%20PROVIDERS

Part 67 – BEHAVIORAL HEALTH CASE MANAGEMENT SERVICES: http://www.okhca.org/xPolicyPart.aspx?id=589&chapter=30&subchapter=5&part=67&title=BEHAVIORAL%20HEALTH%20CASE%20MANAGEMENT%20SERVICES

Part 83 – RESIDENTIAL BEHAVIOR MANAGEMENT SERVICES: http://www.okhca.org/xPolicyPart.aspx?id=597&chapter=30&subchapter=5&part=83&title=RESIDENTIAL%20BEHAVIOR%20MANAGEMENT%20SERVICES

The following is a link to the OHCA proposed rule changes page :  http://okhca.org/providers.aspx?id=12003.  On this page, there is sign up button for “web alerts”.   These alerts will send an email notification when there is a new posting for a proposed rule change.  With each posting on this page, there is an opportunity to complete an electronic feedback form.  The OHCA seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed rule changes page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

4/25/2012 Reminder: 2012 Spring Training Registration

Title: Reminder: 2012 Spring Training Registration

PV: All

Run Date:  04/25/2012 – 05/10/2012

Registration for the Enid Spring Workshop [scheduled for May 9, 2012] will close at 5:00  PM effective 05/02/2012. Walk-in registration will be allowed at this location beginning at 8:00 a.m. on May 9th. Workshops will begin at 8:30 a.m.

OKC and Tulsa registration remains open at this time.  Information and registration is available at:   http://www.okhca.org/xTraining.aspx

We look forward to seeing you this Spring!

4/16/2012 Latest Policy Changes

Title: Latest Policy Changes

Run Date: 04/16/2012 – 05/15/2012

PV Types: 11, 53

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

Dear Behavioral Health Providers:

Several revisions to the existing behavioral health policy were promulgated and went into effect on 3/7/12.  Listed below are links to the policy for different provider types:

The following is a link to the OHCA proposed rule changes page:  http://okhca.org/providers.aspx?id=12003.  On this page, there is sign up button for “web alerts”.   These alerts will send an email notification when there is a new posting for a proposed rule change.  With each posting on this page, there is an opportunity to complete an electronic feedback form.  The OHCA seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed rule changes page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

4/3/2012 Reminder: 2012 Spring Training Registration

Title: Reminder: 2012 Spring Training Registration

PV: All

Run Date:  04/03/2012 – 04/15/2012

Registration for the Durant Spring Workshop [scheduled for April 12, 2012] will close at 5:00  PM effective 04/05/2012. Walk-in registration will be allowed at this location beginning at 8:00 a.m. on April 12th. Workshops will begin at 8:30 a.m.

Enid, OKC and Tulsa registration remains open at this time.  Information and registration is available at:   http://www.okhca.org/xTraining.aspx

We look forward to seeing you this Spring!

3/28/2012 2012 Spring Provider Training Workshop

Title: 2012 Spring Provider Training Workshop

Run Date: 3/21/2012-5/15/2012

PF Type: All

PLEASE JOIN US FOR THE 2012 SPRING PROVIDER TRAINING WORKSHOP!
Providers who attend will get beneficial information on SoonerCare policies and programs. Specific classes include Electronic Provider Enrollment, Provider’s Guide to Member Eligibility, Adjustments/TPL and SoonerCare Beyond the Basics, 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 April 12 followed by: Enid, May 9; Oklahoma City, May 16–17; and, conclude in Tulsa, May 22–23.

3/15/2012 Transportation Claim Modifiers

Title: Transportation Claim Modifiers

Run Date: 03/14/2012 – 04/29/2012

PV Types:

26-Transportation
073-Non ER
260-Ambulance
261-Air Ambulance
262- Bus
263-Taxi

Effective February 8, 2012 when submitting claims with the IH, RH, and SH modifiers, these claims will no longer suspend for review.  It is not necessary to attach documentation when submitting these claims for processing. If you have any further questions please contact the OHCA call center at 1-800-522-0114.

3/9/2012 Comprehensive Treatment Plans – ATTENTION: Orthodontists Only

Title: Comprehensive Treatment Plans – ATTENTION: Orthodontists Only

Run Date: 03/09/2012 – 04/25/2012

PV SPC: 273 – Orthodontists

On 02/01/2012 you received notification of the requirement for comprehensive treatment plans for prior authorization.  This requirement was intended for general dentistry providers only.  Please continue to submit your request as you did previously.

3/1/2012 Attestations for Stage 1 Meaningful Use

Title: Attestations for Stage 1 Meaningful Use

Run Date: 03/01/2012 – 04/15/2012

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

Attestations for Stage 1 Meaningful Use Begins April 1, 2012.

Beginning April 1st, 2012 eligible professionals can begin submitting attestations for Stage 1 of Meaningful Use. To be eligible to attest for Stage 1, you must have 90 days of Meaningful Use. For more information please visit: http://www.okhca.org/EHR-Incentive.

3/1/2012 EHR Participation Year 2011

Title: EHR Participation Year 2011

Run Date: 03/01/2012 – 04/15/2012
PV Types: 31- Physicians
52- State Employed Physicians
09- Advance Practice Nurse
27- Dentist
10– Mid-level Practitioners

EHR Participation Year 2011 is coming to an end.

March 31st, 2012 will be the last day to attest for participation year 2011. If you qualify for the EHR Incentive program, please submit your attestations now. For more information please visit: http://www.okhca.org/EHR-Incentive.

2/15/2012 Secure Site Update – Now Available

Title: Secure Site Update – Now Available

Run Date: 02/15/2011 – 04/01/2012

PV Types: All

The provider secure site is now functional; however, intermittent access issues may be experienced. If the first log-in attempt is unsuccessful, please try again before calling the OHCA Call Center to report the issue. OHCA and HP continue to conduct their research and are closely monitoring the site’s activity.

Please note that some of the claims search features have been disabled (i.e., grayed out) due to their impacts on response time. Specifically, the patient dental history search is currently unavailable, and for all other provider types, the only claim search criterion that is currently available is for ICN. OHCA and HP are diligently working to identify and resolve the issues impacting response times related to searches and plan to re-enable all search features as soon as possible.

We apologize for any inconvenience this may cause.

2/15/2012 Dental History

Title: Dental History

Run Date: 02/15/2012 – 04/01/2012

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


The patient dental history is not currently available. You will be notified when the system again becomes functional.

We apologize for any inconvenience this may cause. Thank you.

2/15/2012 NODOS Submission Dates

Title: NODOS Submission Dates

Run Date: 02/14/2012 – 04/01/2012

PV Types: 01 – Hospitals

Due to the outage of the secure site all NODOS submissions during the week of February 13–19, 2012 will have an effective date of February 10, 2012.

2/15/2012 Claims Submission Extension

Title: Claims Submission Extension

Run Date: 02/15/2012 – 03/01/2012

PV Types: All

As you are aware, there are unexpected difficulties with OHCA’s secure provider site. OHCA is extending the claims submission date until 12:00 noon on Thursday, February 16, 2012.  The payment cycle scheduled for Wednesday, February 22, 2012 remains the same.

2/14/2012 School-Based Training Schedule

Title: School-Based Training Schedule

Run Date: 02/14/2012 – 04/01/2012

PV Type: 12; Spc 120

School-Based Training is scheduled for the following dates and times.
              
March 7, 2012 – Poteau (1:00pm to 03:00pm)
March 15, 2012 – McAlester (10:00am to 12:00pm)
March 27, 2012– Oklahoma City (10:00am to 12:00pm)
March 29, 2012– Stillwater (10:00am to 12:00pm)

Register for training through OHCA website at
http://www.okhca.org/providers.aspx?id=566

2/14/2012 Outpatient Behavioral Health CDC Submission

Title: Outpatient Behavioral Health CDC Submission

Run Date: 02/14/2012 – 04/01/2012

PV Type: 11, 53

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

Attention: Outpatient Behavioral Health Providers

This is to remind you, to enter your CDCs, you should contact gethelp@odmhsas.org. Effective March 1, 2012 claims will deny if you do not have a CDC on file for dates of service March 1 and after. Claims filed with dates of service prior to March 1 will process with or without a CDC on file. You are encouraged to complete a CDC on every member you serve.

Thank you.

2/1/2012 MMIS Extended Maintenance

Title: MMIS Extended Maintenance

Run Date: 02/01/2012 – 02/15/2012

PV Types: All

PLEASE NOTE: Beginning at 6:00 p.m. Friday, February 10, 2012 through 10:00 a.m. Monday, February 13, 2012 our MMIS system will be down for an extended maintenance window. This maintenance involves all access to the system including Electronic Data InterChange (EDI), OHCA Secure Sites, Eligibility Verification System and other major avenues of accessing and submitting information to OHCA.

We apologize for any inconvenience this may cause.

1/31/2012 SoonerCare Online Enrollment Survey

Title: SoonerCare Online Enrollment Survey

Run Date: 01/26/2012 – 02/29/2012

PV Types: All

If you received Provider Letter 2012-01 via facsimile and were not able to access the mysoonercare.org survey through the hyperlink, you can access the survey by visiting http://www.okhca.org/OHCA-Survey-2.aspx.

1/30/2012 Clinical Decisions

Title: Clinical Decisions

Run Date: 01/30/2012 – 03/14/2012

PV Types: 01

Spc:   010; 011; 013; 015

In order to improve our response time on clinical decisions, we will begin accepting telephonic notification on Wednesday, February 01, 2012 for all initial admissions to Acute and Residential Treatment Center (RTC) levels of care, including Upgrades to Acute.  Please note this does not include extension requests. 

Once the clinical template has been faxed to Oklahoma Health Care Authority (OHCA) at (405) 530-7260 and you have received your fax confirmation page, please contact us at (800) 522-0114 and have your Provider ID number ready.  Select option 1 for Provider, option 6 for Prior Authorizations and option 2 for Behavioral Health. You will then be transferred to the Behavioral Health Unit (BHU) where a staff member will locate the faxed template. The staff member will create a case in our system before transferring you to a reviewer. 

These calls will be accepted during regular business hours from 8:00am-5:00 p.m. as our automated phone system is not available after 5pm.

We hope this will improve the Prior Authorization process and will allow you to obtain a decision in a timely manner.  As always thank you for continuing to serve our SoonerCare members.

1/26/2012 SoonerCare Online Enrollment Survey

Title: SoonerCare Online Enrollment Survey

Run Date: 01/26/2012 – 02/29/2012

PV Types: All

If you received Provider Letter 2012-01 via facsimile and were not able to access the mysoonercare.org survey through the hyperlink, you can access the survey by visiting http://www.okhca.org/OHCA-Survey.aspx.

1/18/2012 EPE-01 FAX Cover Sheet

Title: EPE-01 FAX Cover Sheet

Run Date: 01/17/2012 – 02/21/2012

PV Type:  All

REMINDER: 
Providers submitting documentation for provider contracts or contract renewals MUST use the EPE-01 fax cover sheet ONLY.  Sending information with any other fax cover sheet will not allow your documentation to be entered into the system. 

1/12/2012 HP FAX Server Downtime – 2nd Notice

Title: HP FAX Server Downtime – 2nd Notice

Run Date: 01/12/2012 – 01/18/2012

PV Types: All

On Tuesday, 01/17/2012, the FAX server at HP will be down from 6:00-8:00 pm.

This means you cannot FAX any information to HP that would be required for prior authorizations, contract submissions or for attachments to claims. FAXes sent to Insure Oklahoma Will also be affected.

We apologize for any inconvenience this may cause.

1/11/2012 Medicare Non-Covered Transportation Svs

Title: Medicare Non-Covered Transportation Svs

Run Date: 01/10/2012 – 02/24/2012

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

When transportation services are not covered by Medicare, you must appeal the denial to Medicare before sending claims to OHCA.  Please attach the Medicare appeal letter to your claim when sending to OHCA.  We must have this information to determine whether these services can be paid as primary.  OHCA policy states that we can only pay for medically necessary transports. 

1/9/2012 Instructional Letter from ODMHSAS

Title: Instructional Letter from ODMHSAS

Run Date: 01/09/2012 – 02/24/2012

PV Types: 11, 53

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

Attention Outpatient Behavioral Health Providers –
Important: All OPBH providers should have received an instructional letter from the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). The letter from ODMHSAS is to guide you through the process to submit web based CDCs. 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, please contact
 gethelp@odmhsas.org.

In the spring of 2012, the Client Data Core (CDC) will be required as a condition of payment. The start date for this CDC/claim requirement will be announced once the claim system is ready.

1/9/2012 Behavioral Health PA Issues

Title: Behavioral Health PA Issues

Run Date: 01/09/2012 – 02/24/2012

PV Type: 11, 53

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

Attention Outpatient Behavioral Health Providers –

OHCA has temporarily lifted the PA requirement for outpatient BH effective 9/26/11.

Any outstanding OPBH PA request issues that fall between the dates of 9/1/11 to 9/25/11 related to no decisions, extensions or corrections will be reviewed by the OHCA. All review decisions for this designated time period will be based on medical necessity. To process these requests, please provide proof that your original request to APS Healthcare was submitted timely along with documentation supporting your request by faxing to (405) 530-3221. Please provide the original PA number when asking for an extension or correction. All documentation for these specific outpatient OHCA reviews must be received by Jan. 31, 2012. The CDC form which was submitted to APS can be used as proof of the original request.  To access these CDCs, please go to the CDC Data Entry website: http://ok.gov/odmhsas/

1/5/2012 Comprehensive Treatment Plan

Title: Reminder - Comprehensive Treatment Plan

Run Date: 01/04/2012 -02/19/2012

PV Types: 27 – Dentist
  86 – Dental Clinic
  271 – General Dentistry
  274 – Pediatric Dentistry

Dental Provider Reminder: 
Per policy, a comprehensive treatment plan is required documentation when submitting a request for a Prior Authorization.   Please refer to 317:30-5-698. 

Submissions without a comprehensive treatment plan will be returned to the provider without review; this will delay treatment for our members. 

Thank you for your cooperation.

1/5/2012 Transportation Claim Modifiers

Title: Transportation Claim Modifiers

Run Date: 01/03/2012 – 02/18/2012

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

Effective February 1, 2012 when submitting claims with the IH, RH, and SH modifiers, these claims will now suspend for review. Please attach documentation when submitting these claims for processing. If you have any questions please call the OHCA call center at 1-800-522-0114.