2017 Global Messages

 
12/27/2017 2018 Coding Changes

Title: 2018 Coding Changes

The Oklahoma Health Care Authority (OHCA) reviews changes, additions and deletions of both the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes recommended by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) each year. Multiple changes will go into effect on Jan.1, 2018, and it is important to note the following:

Mammography services –The 2017 CMS G-codes for diagnostic and screening mammograms and bundled computer-aided detection (G0202, G0204 and G0206) have been deleted.  Providers should now use one of the following codes to describe these services:

77065  Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral;

77066  Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral; or

77067  Screening mammography, bilateral (2-view study of each breast), including computer-aided detection when performed.

Therapy services – CPT code 97532 has been deleted. The OHCA will recognize CMS G-code G0515 (development of cognitive skills to improve attention, memory, problem solving [includes compensatory training], direct [one-on-one] patient contact, each 15 minutes.) Please note, G0515 will be covered for members aged 0-20 only and will require prior authorization.

12/21/2017  Nursing Facility UPL Application Deadline 

Title:  Nursing Facility UPL Application Deadline

This is a reminder that the deadline to submit initial applications for the nursing facility Upper Payment Limit (UPL) Supplemental Payment Program is 12/29/2017.

The UPL application packet is available on the Oklahoma Health Care Authority’s public website at http://www.okhca.org/providers.

12/8/2017 Potential Member Eligibility Changes Title: Potential Member Eligibility Changes

The Oklahoma Health Care Authority (OHCA) wants to inform you of the possibility that any patients you have enrolled in Soon-To-Be-Sooners or who are covered under Insure Oklahoma Employer Sponsored Insurance (ESI)-dependent child, your patients might have changes in their eligibility in the coming months. 

Funding for these programs is authorized through the Children's Health Insurance Program (CHIP), which expired Sept. 30, 2017. CHIP is a federal program, and the U.S. Congress must reauthorize the funding for services to continue under CHIP authority. As of the date of this letter, re-authorization has not occurred.

CHIP has been providing health coverage to eligible children and pregnant women since it was signed into law in 1997. The OHCA is hopeful the program will continue and to avoid program terminations due to lack of funding.

More information about CHIP and these programs is available at http://www.okhca.org/chip. If your patients have questions, please refer them to the website for the latest news and updates.

Thank you for your service to our members. 
11/17/2017  Dear Provider Letter 2017-35

Title: Dear Provider Letter 2017-35 

Provider Letter 2017-35 serves to inform providers about the implementation of InterQual guidelines in the prior authorization request process. Please post all comments by close of business Monday, December 18, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

11/6/2017 Dear Provider Letter 2017-34

Title: Dear Provider Letter 2017-34

Provider Letter 2017-34 serves to inform providers on the prior authorization for the medications Vimizim and Fabrazyme, effective December 15, 2017. Please post all comments by close of business Wednesday, December 6, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

11/6/2017 Dear Provider Letter 2017-33

Title: Dear Provider Letter 2017-33

Provider Letter 2017-33 serves to inform providers of new emergency rules regarding the three-day signature requirements and adult dental emergency extractions. Please post all comments by close of business Wednesday, December 6, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

10/24/2017  High Risk Obstetrical Services Form CH-17 No Longer Required Per Policy effective 9/1/17 

Title:      High Risk Obstetrical Services Form CH-17 No Longer Required Per Policy effective 9/1/17  

Per policy effective 9/1/17, form CH-17 for High Risk Obstetrical Treatment Plan/Prior Authorization Request is no longer required to be submitted with a prior authorization request for high risk obstetrical services (HROB). The clinical documentation submitted supporting medical necessity for HROB services should have the appropriate signature(s) by Board Eligible/Board Certified Maternal Fetal Medicine (MFM) specialist, or Board Eligible/Board Certified Obstetrician-Gynecologist (OB-GYN).   

For information regarding requirements and submission of a Prior Authorization request for High Risk Obstetrical services, please view the Medical Authorization Unit public webpage at www.okhca.org/mau, select High Risk OB (HROB) link. Also refer to OHCA policy 317:30-5-22.1 Enhanced services for medically high risk pregnancies [Revised 09-01-17].  

If you have additional questions, please call the OHCA Call Center Provider Helpline at (800) 522-0114.     

10/19/2017  Dear Provider Letter 2017-32

Title: Dear Provider Letter 2017-32   

Provider Letter 2017-32 serves to inform providers on the prior authorization requirement for all codes associated with Ventricular Assist Device (VAD) insertion, effective December 1, 2017. Please post all comments by close of business Monday, November 20, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

10/10/2017  Upcoming Change to the Medical Prior Authorization Request Process

Title: Upcoming Change to the Medical Prior Authorization Request Process

 

The Oklahoma Health Care Authority (OHCA) is working to implement InterQual Connect software in its medical prior authorization (PA) request process. More details about InterQual Connect are forthcoming.   

A pilot implementation with orthopedic providers is planned for December 2017. Other medical provider types can expect to see changes in early 2018; however, dental, pharmacy and behavioral health providers will not be affected.   

The InterQual Connect software will present clinical questions relating to medical necessity to which providers can respond.  This process will add to OHCA’s ability to automate and make PA decisions in a more timely way.   

Please note: The primary purpose of this message is to inform you of the minimum software requirements needed to use InterQual Connect. The OHCA would like to allow our providers time to make any needed upgrades.

In order to interact with the InterQual Connect system, providers must use:

  • Monitor with a screen resolution of 1024 x768 or greater   
  • Adobe® Flash® Player 10.x or higher that supports HTTPS https://get.adobe.com/flashplayer/otherversions/
  • Adobe Reader  https://get.adobe.com/reader/otherversions/
  • A web browser that supports TLS 1.2 or higher encryption. The following browsers/versions support the TLS encryption standards by default: 
    • Microsoft Internet Explorer (IE)
      • Version 11 or higher preferred
       
    • Google Chrome (38 and higher)
    • Mozilla Firefox (27 and higher) 
     

Additionally, IE versions 9 and 10 are compatible with configuration changes (see instructions below).

To test your browser for TLS 1.2 encryption compatibility, you can visit https://www.ssllabs.com/ssltest/viewMyClient.html

To upgrade to IE 11, visit the following website: https://support.microsoft.com/en-us/help/17621/internet-explorer-downloads

To enable TLS 1.2 in IE 9 or 10:

  1. On the IE Tools menu, click Internet Options
  2. In the Internet Options dialog box, click the Advanced tab. 
  3. In the Security category, uncheck Use SSL 3.0, and then check Use TLS 1.0Use TLS 1.1, and Use TLS 1.2 (if available). 
  4. Note: It is important to check consecutive versions. Not selecting consecutive versions (e.g. checking TLS 1.0 and 1.2, but not checking 1.1) could result in connection errors. 
  5. Click OK
  6. Exit and restart IE. 
 
10/9/2017 Adult Dental Emergency Extractions Policy Change

Title:  Adult Dental Emergency Extractions Policy Change

 

At their September meeting, the Oklahoma Health Care Authority’s Board of Directors voted unanimously to approve rule revisions that clarify dental coverage for adults.  317:30-5-696. Coverage by category. Adult dental coverage is outlined in OHCA policy 317:30-5-696(1)

Effective November 1, 2017, adult dental services are limited to emergency extractions and the following:

Payment is made for dental services set forth in this section.

(1)    Adults.

(A)   Dental Coverage for adults is limited to:

(i) Emergency extractions, as defined in OAC 317:30-5-695.  Tooth extraction must have medical need documented.

(ii) Limited oral examinations and medically necessary images associated with the emergency extraction or with a clinical presentation with reasonable expectation that an emergency extraction will be needed.

(iii) Smoking and Tobacco Use Cessation Counseling; and

(iv) Medical and surgical services performed by a dentist or physician to the extent such services may be performed under State law when those services would be covered if performed by a physician.

In addition, effective November 1, 2017, CDT D7241 (IMPACT TOOTH REM BONY W/COMP) will require prior authorization.

10/6/2017 C-Section Rates Letters  

 TITLE:       C-Section Rates Letters  

  

The year-end C-section rates letters for state fiscal year 2017 are now available through the OHCA Provider Portal.       

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Provider Helpline.  Choose option 1 for questions concerning the Portal.    

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.      

Thank you. 

10/5/2017 Dear Provider Letter 2017-31

Title: Dear Provider Letter 2017-31

Provider Letter 2017-31 serves to inform providers on the closing of CPT codes, related to speech therapy services, 92605 and 92618, effective October 15, 2017. Please post all comments by close of business Monday, November 6, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

9/18/2017 Changes in Care Coordination Payments

Subject: Changes in Care Coordination Payments 

Since care coordination cannot take place until the member has been seen by their primary care provider we are making changes to the methodology for this payment. Starting January 1, 2018, the Oklahoma Health Care Authority (OHCA) will only pay care coordination fees for members that have had a visit with their assigned provider.  This includes Insure Oklahoma providers and their assigned members as well. On a monthly basis prior to the care coordination payments being calculated, we will look back 15 months to make sure you receive care coordination for all established members aligned with your practice.     

In order to implement this change, contract amendments will need to be signed by all providers prior to November 30, 2017.  The Amendment can be downloaded at www.okhca.org/providerenrollment. The amendment needs to be signed and submitted by fax, or email, to 405-530-3224 or providerenrollment@okhca.org.      

For additional information regarding this change, please review this letter

9/18/2017 Dear Provider Letter 2017-30

Title: Dear Provider Letter 2017-30

Provider letter 2017-30 serves to inform providers on the prior authorization for the Cystic Fibrosis CPT Code, effective October 1, 2017. Please post all comments by close of business Monday, October 16, 2017, via the Oklahoma Health Care Authority Policy Change Blog. Thank you for your participation in the process.

9/18/2017 Long Term Care Cost Reports SFY17 

TITLE:    Long Term Care Cost Reports SFY17   

Long-term care provider cost reports for SFY17 are due by 10/31/17. Facilities may be subject to a rate reduction equal to the amount of the direct care portion of the daily rate ranging from $15.56 to $31.06 per patient day, if cost reports are not received in a timely manner. 

We thank you for your attention to this matter.  
9/12/2017 Update //  Group and Advanced Registered Nurse Practitioner Contracts Expire 11/30/2017

Title:     Update //  Group and Advanced Registered Nurse Practitioner Contracts Expire 11/30/2017

Group and advanced registered nurse practitioner contracts expire November 30, 2017, but the renewal process begins September 18. To avoid any delay in reimbursement, we encourage group and advanced registered nurse practitioners to begin their renewals as soon as possible starting September 18.  

If you have any questions, please contact Provider Enrollment at 1-800-522-0114, option 5. 

9/11/2017 Group and Advanced Registered Nurse Practitioner Contracts Expire 11/30/2017

Title:       Group and Advanced Registered Nurse Practitioner Contracts Expire 11/30/2017

Physician contracts expire November 30, 2017, but the renewal process begins September 18. To avoid any delay in reimbursement, we encourage physicians to begin their renewals as soon as possible starting September 18.  

If you have any questions, please contact Provider Enrollment at 1-800-522-0114, option 5. 

9/11/2017 Changes to the Mailing of Member Identification Cards  

Subject:  Changes to the Mailing of Member Identification Cards    

Effective November 1, 2017, the Oklahoma Health Care Authority (OHCA) will no longer be mailing plastic member ID cards. This is part of our continuing efforts to be fiscally responsible and reduce paper usage.    

However, if a physical member ID card is needed, members have the ability to print cards from their Member Portal.  

As an added convenience, providers now have the option to print ID cards from the SoonerCare Provider Portal. To print a member ID card from the Portal, simply select the Eligibility Tab; check the member’s eligibility and then select “Display Member ID Card.”  If the member does not currently have eligibility, the button will not be displayed. 

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114. 

8/31/2017 Dear Provider Letter 2017-29 

Title: Dear Provider Letter 2017-29 

Provider letter 2016-29 serves to inform providers on pharmacy revisions regarding optional non-prescription products and compounded prescriptions. These revisions will become effective on October 1, 2017 or upon Governor’s approval, whichever is later. Please post all comments by close of business Monday, October 2, 2017, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you for your participation in the process. 

8/31/2017 Dear Provider Letter 2017-28

Title: Dear Provider Letter 2017-28

Provider letter 2016-28 serves to inform providers on the prior authorization of medications used to treat lung cancer, effective October 1, 2017. Please post all comments by close of business Monday, October 2, 2017, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you for your participation in the process.

8/25/2017 Regarding Dear Provider Letter 2017-26

As part of its 2017 permanent rule changes, OHCA amended OAC §§ 317:30-3-4.1(1)(E) and 317:30-3-30(b) to clarify when medical records must be signed and dated, for the purposes of Medicaid reimbursement. The changes were made through the usual permanent rulemaking process, and the agency did not receive any negative comments about the proposed changes during the thirty-day public comment period. In accordance with Oklahoma law, these amended rules will become effective on September 1, 2017.    

OHCA, however, has recently received concerns from numerous SoonerCare providers about the feasibility of the rule changes – specifically, the revised language that requires medical records to be signed and dated within three days of the provision of the underlying service. OHCA is committed to working with our partners to ensure that a more flexible timeframe for record authentication is established via rulemaking, as quickly as possible. OHCA plans to accomplish this by:

1) submitting emergency rules to Governor Fallin that would return the timeframe for medical record authentication to the timeframe in effect today (where authentication is “expected on the day the record is completed,” or, if the medical record is transcribed by someone other than the provider, “within three business days from the day the record is completed”); and

2) in collaboration with our partners, drafting new, permanent rule changes for medical record authentication that are both clear and unambiguous, and respectful of the realities of healthcare practice.

It is expected that OHCA will be able to submit the aforementioned emergency rule changes to Governor Fallin’s office shortly after its scheduled October 12, 2017, Board meeting. In the meantime, OHCA would like to assure its providers that during this limited window (from September 1, 2017 until the emergency rules become effective); the 3 day rule will not be added to the OHCA audit protocol.

8/17/2017 Change to the PCMH Application Process

Title: Change to the PCMH Application Process

 

The Oklahoma Health Care Authority has updated the application process for practices seeking to become a patient-centered medical home (PCMH), as well as for practices seeking to increase their current PCMH level.

Moving forward, onsite visits will be part of the review process for new PCMH applicants as well as existing medical homes requesting to advance to the next level.

Providers will also have a different designation. Instead of being referred to as Tier One, Tier Two and Tier Three PCMHs, they will be known as Entry-, Advanced- and Optimal-level PCMHs.   

In addition, the deadline to apply for an increased PCMH level has been moved up to September 30. This allows more time for providers to schedule and receive an onsite visit prior to January 1 of the following year.

For more information on SoonerCare medical homes, please visit our PCMH webpage at www.okhca.org/medical-home. If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114, option 1.

8/10/2017 Therapy Authorization Reviews and Guidelines

Title:  Therapy Authorization Reviews and Guidelines

Run Dates:  7/25/2017 – 8/24/2017

PV Types:  01, 08, 17, 012, 173, 174, 175

Effective July 1, 2017 the Prior Authorization processes for Speech, Physical, and Occupational Therapy transferred to the Oklahoma Health Care Authority.   

Please review the Therapy Guidelines and Required Forms at http://www.okhca.org/therapy prior to submitting your therapy requests. If you have submitted a duplicate submission, because you have not received a decision, please log into the Provider Portal and cancel your duplicate submissions. You can do this under “View Authorization Status,” then locate the “View Original Request” and then cancel your duplicate request. OHCA is working as efficiently as possible on all therapy cases. Each prior authorization submitted must be processed.  The cancellation of duplicate submission will help decrease the number of actual prior authorizations that need to be reviewed. Thank you for your consideration in this matter.

Also, please note, the rule of no retroactive authorization for Speech, Physical, and Occupational Therapy services remains in effect.

8/10/2017 Proper Submission of Dental Claims Adjustments

Title: Proper Submission of Dental Claims Adjustments

PV Types: 27, 08

Occasionally billing errors occur.  The Oklahoma Health Care Authority finds that the most common dental errors are billing the wrong tooth number or quadrant.

If an error does occur, please do not void a dental claim that is past the six month timely filing deadline.  Instead, submit an HCA-15 for an adjustment to a paid claim detail.  You can download the form on the public website at www.okhca.org/forms.

8/8/2017 Regarding Dear Provider Letter 2017-26

Title: Regarding Dear Provider Letter 2017-26

PV Types: All

Provider Letter 2017-26 informs providers about changes being made to signature requirements, effective September 1, 2017.  OHCA will be going through the emergency rule process to further clarify this rule.

8/3/2017 Program Integrity Audits/Reviews Revisions – Effective September 1, 2017

Title:       Program Integrity Audits/Reviews Revisions – Effective September 1, 2017 

PV Types:    All 

Title: Program Integrity Audits/Reviews Revisions – Effective September 1, 2017

 

The Oklahoma Health Care Authority (OHCA) has made policy changes, which were promulgated through the 2017 legislative session per the Administrative Procedures Act. All policy changes are effective September 1, 2017 and will be posted to the policy website on that date. In the interim, a comprehensive summary of the change is listed below. 

Please note, the Oklahoma Administrative Code link identified below will be updated with the new policy changes on September 1, 2017.    

Program Integrity Audits/Reviews policy at 317:30-3-2.1 is revised to clarify the OHCA audit process by: explaining that the scope of audits may include examination for fraud, waste, and/or abuse of the SoonerCare program; establishing a clearly defined response due date for providers who want to request an informal reconsideration and/or formal appeal of audit findings; and by informing providers that overpayments identified through the audit process may be withheld from future payments if the provider fails to timely contest the underlying audit findings.

8/1/2017 Dear Provider Letter 2017-24

Title: Dear Provider Letter 2017-24

PV Types:   01, 02, 08, 09, 10, 13, 16, 28, 31, 52, 57

Provider letter 2016-24 serves to inform providers on the prior authorization of several molecular pathology CPT codes, effective September 1, 2017. Please post all comments by close of business Thursday, August 31, 2017, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you for your participation in the process.

8/1/2017 Dear Provider Letter 2017-25

Title: Dear Provider Letter 2017-25

PV Types:   05   

Provider Letter 2017-25 provides additional guidance regarding face-to-face requirements, that was addressed in Provider Letter 2016-24, for home health services.

8/1/2017 Dear Provider Letter 2017-26

Title: Dear Provider Letter 2017-26

PV Types: All

Provider Letter 2017-26 informs providers about the important changes made to signature requirements, effective September 1, 2017.

6/30/2017 New Long-Term Care Facilities Rate Effective July 1, 2017

Title: New Long-term Care Facilities Rate Effective July 1, 2017  

Effective July 1, 2017, long-term care facilities rates will change.   

The Oklahoma Health Care Authority (OHCA) mailed a letter dated June 29 to each facility stating the new rate.

In addition, the new rates are available on the OHCA website. Please click here to view.

6/28/2017 Documentation for Orthodontic Prior Authorizations

Title:  Documentation for Orthodontic Prior Authorizations

Effective May 1, 2017, the Oklahoma Health Care Authority (OHCA) updated the HLD Index of Malocclusion. OHCA gave notice of this change in Provider Letter #2017-06.

Providers can download the updated form (DEN-6) from the OHCA website at www.okhca.org/forms. Please update your system accordingly.

Please note that all requested information should appear on your documentation: provider name and ID, member name and ID, dates, signatures and scoring.  Any incomplete documentation will be returned. In addition, any form submitted that is altered or changed from the OHCA-designated form will also be returned.

Thank you for your cooperation. Call 405-522-7401 if you have questions.

6/26/2017 C-Section Rates Letters

TITLE:    C-Section Rates Letters

C-section rates letters for the third quarter of state fiscal year 2017 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Provider Helpline.  Choose option 1 for questions concerning the Portal.

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.

6/13/2017 Change in Patient Dismissal Process for SoonerCare Choice Medical Homes

Title: Change in Patient Dismissal Process for SoonerCare Choice Medical Homes

Attention SoonerCare Choice Medical Homes (PCMH Only): A new process to dismiss members from your SoonerCare panel will go into production on June 15, 2017. All requests will be processed through the SoonerCare Provider Portal.  Portal Administrators must grant permission to clerks who need this role within your practice. Also, please remember supporting documentation must be uploaded with your request. Approval/denial letters will post to the “Letter” tab in the Portal.

We presented training for this change during the 2016 SoonerCare Fall Provider Training Workshop. You can view that presentation online at www.okhca.org/providertraining

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114, option 1.

6/7/2017 Imaging and Therapy Retroactive Prior Authorization Days and New Therapy PA Form

Title:  Imaging and Therapy Retroactive Prior Authorization Days and New Therapy PA Form

Run Dates:  6/01/2017 – 7/31/2017

PV Types:  01, 02, 03, 05, 06, 08, 09, 10, 12, 13, 14, 17, 20, 29, 31, 52

Effective July 1, 2017, as stated in Provider letter #2017-07, Prior Authorization processes for Imaging and Speech, Physical, and Occupational Therapy will transfer to the Oklahoma Health Care Authority.   

Please note that the rule of no retroactive authorization for Speech, Physical, and Occupational Therapy services remains in place. Imaging procedures continue to allow 3-day retroactive prior authorizations.   

In addition, a new form (HCA-61), Therapy Prior Authorization Request Form, has been created to request prior authorization for outpatient speech, physical, and occupational therapy services. This form must be submitted with supporting clinical documentation effective July 1, 2017 and can be found at http://www.okhca.org/.

6/5/2017 Service Quality Review Process

Title: Service Quality Review Process

Run Dates: 6/5/2017 – 7/1/2017

PV Types: 45, 01

Effective July 1, 2017, all psychiatric treatment facilities and therapeutic foster care agencies providing services for SoonerCare members under age 21 will be required to submit documents for the Service Quality Review (SQR) through the secure Provider Portal (www.ohcaprovider.com).The Oklahoma Healthcare Authority (OHCA) will no longer accept any hard copy documents.

Pursuant to 42 CFR 431.107, ALL documents requested in the introduction letter from the SQR Team must be submitted electronically. Late submissions may not be accepted and could affect the review process.

If you do not have access to the OHCA Provider Portal or have questions, please contact the Behavioral Health Operations Unit at 405-522-7017.

6/2/2017 Important Changes to the Referral Process – Effective September 1, 2017

Title:  Important Changes to the Referral Process – Effective September 1, 2017

Run Dates: 6/1/2017-7/15/2017

PV Types: All

Beginning September 1, 2017, electronic referrals through the SoonerCare Provider Portal will no longer be available for SoonerCare Choice Medical Homes or Insure Oklahoma (PUB) providers. This change will give providers flexibility to adopt a referral process that works better for their individual practices.

Claims submitted on or after September 1 will no longer require an electronic referral, and providers may begin using alternative referral methods. As an option, an updated paper referral form (SC-10) will be made available.

For full details regarding this change, please refer to Provider Letter OHCA 2017-09 found at www.okhca.org/providerletters

 

If you have any questions or need additional training, please call the OHCA Provider Helpline at 1-800-522-0114

5/18/2017 Dear Provider Letter 2017-10

Title: Dear Provider Letter 2017-10

Run Dates: 5/17/2017-6/15/2017

PV Types:   01, 080, 081, 082, 084, 088, 090, 092, 093, 100, 191, 192, 290, 291, 316, 318, 322, 325, 326, 334, 339, 341, 344, 345, 349, 359, 523, 553, 560

 

Provider Letter 2017-10 serves to inform providers on the prior authorization for CPT code 95951 and medical review for CPT code 95957, effective June 15, 2017.  Please post all comments by close of business, Monday, June 19, 2017 via the policy change blog. Thank you for your participation in the process.

4/18/2017 Therapeutic Foster Care Claims Submissions

TITLE:             Therapeutic Foster Care Claims Submissions

Run Date:        04/17/2017 – 06/01/2017

PV Type:         45 – RBMS Therapeutic Foster Care

 

Beginning May 1, 2017, therapeutic foster care (TFC) agencies submitting claims for payment to OHCA will be required to include the rendering providers assigned to their Oklahoma Medicaid Group ID on the claims.

The rendering service provider receives payment for Medicaid-compensable health care services on behalf of the stated group (in this case, the TFC agency). This provider also directs the OHCA to make all such payments to the group. This does not affect any other agreement the rendering provider has with the OHCA.

Please note: OHCA does not make direct payments to the rendering provider.    

After May 1, 2017, TFC agencies that do not submit rendering providers on their claims will receive denials in the claims system for payment.     

If you have questions, please call the OHCA Provider Helpline at 1-800-522-0114 and select option 6.

4/18/2017 Dear Provider Letter 2017-06 

Title:     Dear Provider Letter 2017-06 

Run Date: 04/17/2017 – 06/01/2017 

PV Types:  273, 278 

  

Provider Letter 2017-06 serves to inform providers on the updated version of the Handicapping Labio-Lingual Deviation (HLD) Index of Malocclusion for comprehensive orthodontic services.   

4/7/2017 Dear Provider Letter 2017-07 

From:            Oklahoma Health Care Authority 

Run Date:      4/07/17 – 05/17/2017 

Subject:        Dear Provider Letter 2017-07 

PV TYPE:       01, 02, 03, 05, 06, 07, 08, 09, 10, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 23, 25, 26, 28, 29, 30, 31, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 57, 58, 59, 60, 61 

Provider Letter 2017-07 serves to inform providers on the transition to a fully electronic prior authorization submission process, effective July 1, 2017 .  Please post all comments by close of business, Monday, May 8, 2017 via the policy change blog. Thank you for your participation in the process. 

4/6/2017 2017 Spring Provider Training Workshop  

Title:                    2017 Spring Provider Training Workshop    

Run Date:             04/06/2017 – 05/26/2017    

Provider Type:       All    

  

You and your staff are invited to attend the Spring 2017 SoonerCare Provider Training Workshops.    

Classes include:  SoonerCare 101, Beyond 101, Health Literacy, TPL Logistics, Dental, Medical Authorization Tips, the Upper Payment Limit Program, Lead Poisoning Prevention and SoonerCare Updates and Changes.    

Class descriptions (found in the link below) explain the covered topics and recommended audience. Classes fill up fast, so mark your calendar and register now!    

Information and registration is available at:    

http://www.okhca.org/provider-training    

Lawton, OK will be the first stop on April 13 followed by Durant, April 27, Tulsa May 17-18 and OKC May 24-25. 

4/4/2017 Quality of Care (QOC) Report Submission Confirmation Email

Subject:               Quality of Care (QOC) Report Submission Confirmation Email

Run Date:            4/03/17 – 05/17/2017

PV TYPE:              03 – Long Term Care

This is to inform Long Term Care (LTC) facilities that beginning April 1, 2017, upon submission of your monthly QOC Report a confirmation email will be sent to the email address listed for your facility in the FOE/QOC portal.

Please make sure the correct email address is listed in the FOE/QOC portal.  If you do not receive a confirmation email there has been a problem with the QOC Report submission. The user must research the problem as this will indicate the report has not been sent and penalties are subject to apply.   

If you have any questions regarding this new functionality, contact Darla Cohee at 405-522-7063.

4/3/2017 Services no longer requiring prior authorization  

Title:  Services no longer requiring prior authorization    

Run Date: 03/31/2017-05/31/2017   

PV Types: 01, 02, 08, 09, 10, 31, 52    

Effective April 1, 2017, the Oklahoma Health Care Authority (OHCA) will no longer require prior authorization (PA) for the following CPT/HCPCS codes: 

0191T 65772 97602
0394T 65775 G6015
0395T 66183 G6016
52287 77767 P9070
54110 77768 P9071
56700 77770 P9072
64615 77771  
65770 77772  

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114.  

 
3/30/2017 C-Section Rates Letters 

TITLE:       C-Section Rates Letters

Run Dates:   3/30/2017 – 05/15/2017 

PV Types:    01, 08, 31, 52 

  

Second quarter C-section rates letters for state fiscal year 2017 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.    

If you need help to retrieve your letters, please call 800-522-0114, option 2, for the Internet Helpdesk; choose option 1 for questions concerning the Provider Portal.     

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.    

Thank you. 

3/22/2017 Intensity Modulated Radiation Therapy Services Coverage  

Title:           Intensity Modulated Radiation Therapy Services Coverage 

Run Date:  03/21/2017 – 05/05/2017 

PV Types:  01 – 10; 14, 15, 16 

    

Effective April 1, 2017, the Oklahoma Health Care Authority (OHCA) will allow the following CPT codes for reimbursement for services provided in an outpatient hospital setting.  These services are billable by facilities only.  

·        CPT 77385- Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple 

·        CPT 77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 

·        Use G6001 or G6002 for guidance, based on method used. 

3/10/2017 Dear Provider Letter 2017-04  

TITLE:               Dear Provider Letter 2017-04 

RUN DATE:        03/10/2017 – 04/10/2017 

PV TYPES:         02; 080; 081; 184; 195; 329; 354; 356; 522; 540 

  

Provider Letter 2017-04 serves to inform providers on the prior authorization of medications used to treat skin cancer, effective April 10, 2017.  Please post all comments by close of business, Monday, April 10, 2017 via the policy change blog. Thank you for your participation in the process. 

2/17/2017 Fetal Echo Services Coverage Title: Fetal Echo Services Coverage

Run Dates: 02/17/17 - 05/01/2017 

PV Types: 199, 091, 328, 550, 335

Effective March 1, 2017, the Oklahoma Health Care Authority (OHCA) will open the following CPT codes for services when provided by a pediatric cardiologist. Coverage will require a prior authorization.   

 

  • CPT 76825 Echocardiography, fetal, cardiovascular system, real-time with image documentation (2D) with or without M-mode recording  
  • CPT 76826 Follow-up or repeat study  
  • CPT 76827 Doppler echocardiography, fetal, pulse wave and/or continuous wave with spectral display; complete  
  • CPT 76828 Follow-up or repeat study  

 

OHCA considers fetal echo a necessary evaluation tool when a cardiac anomaly is suspected. 

2/10/2017  Dear Provider Letter 2017-03 

Title:        Dear Provider Letter 2017-03 

Run Dates:    02/10/2017 – 03/10/2017 

PV Types:      260 

  

Provider Letter 2017-03 serves to inform providers on Insure Oklahoma coverage for emergency ground ambulance services.   

  

Please post all comments by close of business, Thursday, March 9, 2017 via the policy change blog. Thank you for your participation in the process. 

1/12/2017 Mammography Services 

Title: Mammography Services 

PV Types: 01, 08, 09, 10, 29, 31, 52

Run Date:  01/13/2017 – 02/28/2017

 

The Oklahoma Health Care Authority (OHCA) reviews changes, additions and deletions of both the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes recommended by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) each year. Multiple changes went into effect Jan. 1, 2017, and it is important to note the following: 

  

Mammography services - The 2016 CPT codes for diagnostic and screening mammograms (77055, 77056, 77057) as well as codes for computer aided detection (77051, 77052) have been deleted. OHCA now uses the CMS G-codes for mammography and bundled computer aided detection as follows:

·         G0206 - Diagnostic mammography, include computer aided detection (CAD) when performed; unilateral.

·         G0204 - Diagnostic mammography, include computer aided detection (CAD) when performed; bilateral.

·         G0202 - Screening mammography, bilateral (2-view study of each breast), including computer aided detection (CAD) when performed.

 

If the mammogram is taken using film, providers must apply modifier FX (X-ray taken using film), which will result in a payment reduction for the technical portion of the claim.

 

1/12/2017 Controlled substance monitoring and drugs of abuse testing 

Title: Controlled substance monitoring and drugs of abuse testing 

PV Types: 01, 08, 09, 10, 28, 31, 52

RUN DATES:       01/12/2017-03/01/2017

 

The Oklahoma Health Care Authority (OHCA) reviews changes, additions and deletions of both the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes recommended by the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) each year. Multiple changes went into effect on Jan.1, 2017 and it is important to note the following: 

 

Controlled substance monitoring and drugs of abuse testing - the 2016 CMS HCPCS codes for presumptive testing (G0477, G0478, G0479) have been deleted. OHCA now uses newly established AMA CPT codes for presumptive testing as follows:

·         80305 - Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical observation only (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service. 

·         80306 - Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, (e.g., immunoassay) read by instrumented assisted direct optical observation (e.g., dipstick, cups, cards, cartridges) includes sample validation when performed, per date of service. 

·         80307 -  Drug test(s), presumptive, any number of drug classes, qualitative; any number of devices or procedures, by instrument chemistry and analyzers (e.g., utilizing immunoassay [EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (e.g., GC, HPLC), and mass spectrometry either with or without chromatography, (DAT, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service. 

 

As a reminder, only one unit of any of these three presumptive tests is allowed per day when medically indicated. The tests are differentiated by the methodology utilized to perform them.

 

Furthermore, DEFINITIVE urine drug testing continues to require prior authorization.  You can view OHCA’s guidelines at http://www.okhca.org/providers.aspx?id=18608   

 

OHCA expects quality services and adherence to Clinical Laboratory Improvement Amendments (CLIA) requirements and will not allow new HCPCS G0659 - (Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem), excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes).

1/5/2017 OHCA Provider Letter 2017-01 Termination of Perinatal Dental Coverage 

Title: OHCA Provider Letter 2017-01 Termination of Perinatal Dental Coverage 

Run Date:    01/05/2017 – 02/07/2017 

PV Types:    027, 086, 199, 214, 328 

  

OHCA will terminate perinatal dental coverage, effective February 1, 2017. Details can be found in Provider Letter 2017-01.      

Providers have an opportunity to provide feedback on this change. Please post all comments by close of business on February 6, 2017, via the OHCA Policy Change Blog at www.okhca.org/policyblog.    

Thank you for participating in the process. 

1/3/2017 C-Section Rates Letters  

TITLE:       C-Section Rates Letters  

Run Dates:   01/03/2017 – 02/18/2017 

PV Types:    01, 08, 31, 52 

  

First quarter C-section rates letters for state fiscal year 2017 are now available through the OHCA Provider Portal. As a reminder, these C-section letters are now only available electronically.    

If you need help to retrieve your letters, please call 800-522-0114; option 2 for the Internet Helpdesk; option 1 for questions concerning the Provider Portal.     

You may also view the C-section rates release schedule on the OHCA webpage at www.okhca.org/c-section.    

Thank you.