2007 Global Messages

Current Global Messages
2006 Global Messages

 

Effective Date

Subject

Message

     

12/21/2007

Rate Change

Title: Rate Change

PVs: School Corp - Type: 12 / Spc: 120

Run date: 12/21/2007 – 02/05/2008

Please be advised of a rate change effective January 1, 2008 for CPT codes 90804 and 90853.  The new rates are: $43.71 (Code 90804) and $23.85 (Code 90853).  The EPSDT School-based fee schedule has been updated to reflect the new rates and can be downloaded from the OKHCA website.

12/21/2007

NPI Update / Reminder

Title: NPI Update / Reminder

Run Date: 12/21/2007 – 02/05/2008

To: PV Types: 01 thru 23; 24; 26 thru 30;  31, 48, 52, 53,

Specialties: 010 - 016; 020; 031 - 037; 040, 060, 071, 072, 073, 080 - 095; 100; 101; 110 - 121; 130, 140, 150, 160 - 163; 170 - 175; 180 - 185; 190, 200; 210, 211, 213 - 228; 230, 240, 260 - 267; 270 - 277; 280, 281, 290, 291, 292, 300, 310, 311 - 347;  480, 530, 531 - 535

REMINDER: The final day for implementation of NPI is May 23, 2008. Beginning in early 2008 OHCA will process claims with NPI to ensure there is no delay in your claims payment.  Claims submitted without the rendering and pay-to NPI numbers during this testing period could deny.

Have you submitted all of your NPI numbers to us? Have you applied for all the NPI numbers available to you?

Only 82% of our providers have submitted their NPI to the Provider Enrollment office.

Avoid the risk of a decreased cash flow to your practice as a result of neglecting to satisfy this requirement in the claims payment process.

Please fax the following information to Provider Enrollment, 405-530-3224, as soon as possible: 1. All NPI numbers you have received from CMS; and, 2. all the OHCA Provider Numbers, including the alphabetical location code, associated with each NPI.

FYI: Medicare will deny institutional claims without the appropriate NPI beginning 01/01/2008. Medicare will deny individual provider claims without appropriate NPI number beginning April 2008.

12/20/2007

Postponement of January 1, 2008 PA Process

Title: Prior Authorization Process Update

Provider Type: All

Run Date: 12/20/2007 – 02/10/2008

Re: Postponement of January 1, 2008 Prior Authorization Process Referenced in Provider Letter 2007-44 Prior Authorizations

Provider Letter 2007-44 notified you of an upcoming change in the prior authorization process scheduled to begin January 1, 2008.  This message is to advise you that the effective date of this change has been postponed. We continue to review our current prior authorization process to ensure timely responses to you and to explore other avenues to streamline the prior authorization process.

For questions related to the prior authorization process contact Medical Authorization Unit (MAU) by calling 1-800-522-0114 option 6; or, Provider Services Department at 1-877-823-4529, option 2.

Thank you for all you do for our SoonerCare and Insure Oklahoma members.

12/18/2007

1500 and UB-04 Paper Claims

Title: 1500 and UB-04 Paper Claims

Run Dates: 12/13/2007 – 02/01/2007

To: All Provider Types

Dear Provider Letters 2007-54 & 2007-55 were recently sent regarding the use of the new 1500 claim or the new UB-04 form when filing claims with NDC numbers. The letters were to assist your staff in filing these claims with the appropriate information included for claims processing.  Although these instructions do not apply to everyone, we wanted to ensure that all providers are using the new 1500 or UB-04 claim forms when filing paper claims effective January 1, 2008.

Claims currently in the system under review will be processed by agency staff. Please do not resubmit claims that have not completed the system processing. If you have any questions please call Provider Services at 1-877-823-4529 Option 2.

Thank you for all you do for our SoonerCare and Insure Oklahoma members.

12/14/2007

Non-emergency Stretcher Services

Providers: 26 – Transportation    Spc – 073 – NET (non-emergency transportation)

Run Dates: 12/07/2007 – 06/15/2008

Effective January 1st all non-emergency transports, including stretcher services for SoonerCare members must be scheduled through SoonerRide. 

Transportation providers that want to continue providing these services must have a contract with SoonerRide and will receive reimbursement directly from SoonerRide.   Contact Logisticare at 1-405-499-0060 and ask for Steven Feist or Sherry Peters regarding contracting.  For stretcher service and hospital discharges call 1-800-435-1276.  This number is answered 24 hours a day 7 days a week.

A Provider Letter will be issued in the near future regarding Non-Emergency Stretcher Services. Thank you for your continued services to OHCA members.

12/6/2007

OT/PT Prior Authorizations

Provider Types: OT/PT:spc:  

170 – Physical Therapist

171 – Occupational Therapist

174 – OT Assistant

175 – PT Assistant

336 – Physical Medicine & Rehab Practitioner

Currently, prior authorizations for Physical Therapy and Occupational Therapy are renewed every 6 months. Effective 01/01/2008 Physical Therapy and Occupational Therapy can be prior authorized for up to 12 months. Existing authorizations will not be extended to the 12 month period but can be requested at the time of renewal.

Thank you for your continued support of OHCA members.

11/6/2007

November 2007 OHCA Holiday Schedule

OHCA, the SoonerCare Helpline and the EDS Call Center will be closed in observance of the following State holidays: November 12th, 16th, 22nd and 23rd.  The Secure Site will be available to check eligibility and Claims status during these times.

11/5/2007

Changes to Procedure Codes 17000, 17003 & 17004

Effective 09/01/2007, Procedure Codes 17000 through 17004 will process without Prior Approval (PA) or medical review when submitted with an appropriate Diagnosis Code. The approved diagnosis code for any of these procedure codes is 702.0. Without a proper procedure/diagnosis code combination, procedure codes 17000, 17003 and 17004 will suspend for medical review if documentation is attached to the claim or deny if no documentation is attached.

10/29/2007

Helpful Tips re: HCA-13 Coversheet for Paper Attachment to

Electronic Claim or Prior Authorization

Here are some Helpful tips to successfully create an Attachment Control Number (ACN) on Form HCA-13 (Coversheet for Paper Attachment to Electronic Claim).

To ensure the required attachment and electronically submitted claim are matched up appropriately in the system, the ACN used by the provider must be UNIQUE and can NEVER be repeated.

Only Alphabetic and Numeric characters can be used when creating an ACN. DO NOT use dashes, spaces or special characters in ACN’s.

DO NOT use confidential member information such as the member’s Social Security Number, date of birth, or name as an ACN. This type of information is easily identifiable and is considered a violation of HIPAA regulations if used.

The billing/pay-to Provider Number shown on the claim must be the Provider Number shown on the HCA-13. The Provider Number, Recipient (RID) Number, and ACN must all match exactly on both the claim and its attached HCA-13.

To avoid a delay or a halt in the attachment process, please ensure that all information shown on the HCA-13 is clear and legible.

10/29/2007

Reminder: Prior Authorization# (PA)

Reminder: When filing a paper 1500 claim form, the PA number is not required. The system checks for the PA when the claim is filed. If CLIA services are provided, the CLIA number is to be shown in Box 23.

Thank you for your continued services to the Members of OHCA.

09/27/2007

Disproportionate Share (DHS) Hospital Payments

On July 18, 2007 and again on September 26, 2007, hospitals received their DSH payment from OHCA. These payments represent the total amount allocated to OHCA for DSH for Federal Fiscal Year 2007. Please check the OHCA Web site for additional information about the state's DSH program.

09/14/2007

DME

As you are aware, the fee schedule for HCPCS codes A0021 through V5364 was updated effective 9/1/2007 with some revisions to quantity limits. It may appear that the limits are more restrictive than they actually are, due to Web site limitations. Please enter the appropriate 'From' and 'Through' service dates on claims for supplies that will be used over multiple days. Do not enter a single date e.g., the delivery date only on a claim for items that will be used over more than one day. If the supply is delivered for use over the last two weeks of November, enter 'From: 11/15/2007 thru 11/30/2007.' By regulations, OHCA can only pay for supplies intended for use prior to the billing date. In the example above, the earliest the claim can be processed for payment is 11/30/2007. The revised HCA-12A authorization request form, effective 10/1/2007 also has fields for entering 'From' and 'Through' service dates.

09/14/2007

DME Fee Schedule Changes

As you are aware, the fee schedule for HCPCS codes A0021 through V5364 was updated effective 9/1/2007 with some revisions to quantity limits. It may appear that the limits are more restrictive than they actually are, due to Web site limitations. If you have any questions, please contact Provider Services at 1-877-823-4529, Option 2. The OHCA is committed to quality and cost effective services to our members. We look forward to a continued relationship with you and appreciate the services you provide to our SoonerCare and O-EPIC members.

09/14/2007

TOP Payments

OHCA has processed the SFY TOP payments and they will appear on remits dated 9/19/2007. For more information detailing the TOP, download the PDF file.

09/11/2007

Follow-up to OHCA Letter 2007-38

As stated in OHCA Letter 2007-38, effective September 1, 2007, the HCA-28 form, Medicare/Medicaid Crossover Invoice, must be attached to all Crossover Claims for accurate processing. Remember to file your claims on the new CMS-1500 form and attach the HCA-28, Medicare/Medicaid Crossover Invoice. If you have any questions please call Provider Services at 1-877-823-4529 option #2.

Thank you for your continued service to SoonerCare members.

08/22/2007

Medicare Crossovers Re: Medicare Number

The majority of claims from Medicare are automatically sent to SoonerCare for processing. If your crossover claim begins with "20" that denotes that the claims appear to be crossing over automatically and only exceptions should be sent on paper claims. If you believe that your crossover claims are not automatically crossing to SoonerCare, contact the OHCA Call Center to see if we have your Medicare number on file for each of your SoonerCare provider numbers. If there is not a valid Medicare number associated with your SoonerCare number, you will be transferred to Provider Enrollment to update your provider file. Check to see if your crossover claims are crossing automatically. Doing so will save time and money.

08/22/2007

HIPAA Remark Codes

Do you find the HIPAA Remark Codes hard to understand? When researching claims on the Secure Site, click on the blue HIPAA remark or adjust reason code and a more detailed explanation for the denial or suspense will appear below the blue reason code. The code appears blue because it is a hyperlink.

07/18/2007

Medicaid Crossovers

CMS has informed State Medicaid plans that providers may have received EOMB's reflecting that claims have crossed over to Medicaid when in fact the claims were denied by Medicare for HIPAA reasons. The time period was prior to July 1. Providers will be sent a report from Medicare notifying them of the rejected claims. Please contact your Medicare intermediary or CMS with questions.

07/11/2007

Psychosocial Assessment Form

Please disregard and DO NOT USE the Psychosocial Assessment Form and instructions that were attached to the Provider Letter OHCA 2007-41 dated 07/02/2007. The form has been revised and that version will be placed on the Web site by 07/13/07. We apologize for any inconvenience that this may have caused. Thank you.

06/30/2007

UPDATED INFO - New FAX # for Member Dismissals Only

ADDITIONAL INFORMATION: Please submit your written Request(s) for Patient Dismissal (preferably on your office letterhead paper) and include the following necessary information: 1. patient name and SoonerCare Recipient ID number, 2. provider name and number, and, 3. reason for and documentation justifying the request. Requests cannot be processed without this information. Please fax requests for Member Dismissals to 405-530-3228. Thank you.

 

06/20/2007

Otoacoustic Emissions Testing

Procedure Code 92587: Evoked Otoacoustic Emissions, Limited: This test has NOT been limited to ENT and Audiology providers. If claims for dates of service beginning January 2007 have been denied for Nurse Practitioners or Physician Assistants, they may be resubmitted.

FYI: OAE testing is NOT recommended by ASHA for screening of: adults or children school age and above; in the presence of middle or outer ear pathology; unless sensory neural loss is suspected.

OAE testing will NOT detect mild hearing loss or auditory neuropathy.

     

Effective Date

Subject

Message

05/23/2007

Web Alerts

To further enhance communication, OHCA has implemented web alerts. The following alerts are available through the provider page to anyone who wants updates from the Oklahoma Health Care Authority.

Global Messages
Medical Review Guidelines
Provider Letters
Provider Newsletter Updates
Pharmacy Updates
Publications/Research

Web Alerts are added weekly. When the project is complete every page of the web site will have a web alert.

Subscribing is easy. Just go to www.okhca.org. On the right hand side under “What’s New”, you will find Web Alerts. Please take a few minutes to sign up today.

05/17/2007

OHCA Finalizes NPI Implementation Plan

After talking with providers and listening to conference calls with CMS, OHCA has determined that NPI will be required on all electronic claims May 23, 2008. This new date will allow providers to obtain their NPI and make sure OHCA has the NPI in our system. We will continue the dual use period until May 22, 2008. Please continue to file your 837 claims with both your NPI and Legacy ID's. Pharmacies will continue to file claims with your Legacy Provider ID and the OHCA prescriber numbers. Claims will process with the Legacy ID until May 22, 2008. CMS will continue to provide Legacy ID's on their EOB for cross over claims processing through May 22, 2008.

05/17/2007

Updated Pricing

The Oklahoma Health Care Authority has updated its pricing on the following CPT and/or HCPCS code(s) effective 05/15/07.

REASON FOR UPDATE: INDUSTRY STANDARD

Effective 05/15/07, procedure code 59015 (Chorionic villus sampling, any method) will be covered for eligible SoonerCare members 10-50 years of age if medically necessary.

Thank you for your continued service to SoonerCare members.

05/15/2007

Perinatal Dental Coverage - Correction to Letter 2007-12

The OHCA 2007-12 letter, dated March 16, 2007, inadvertently listed procedure code D2390 as part of the coverage included in the Perinatal Dental Program. Please make your staff aware of this oversight.

We apologize for any confusion this may have caused. All other procedures codes listed in this letter are valid.

Thank you for your continued support of all SoonerCare Programs.

05/07/2007 TeleInterpreters' OPI Service

TeleInterpreters' OPI Service is now available to SoonerCare Providers for their non-English speaking SoonerCare Choice patients. Please follow the instructions from the Users' Guide below.

TeleInterpreters' OPI Users' Guide
Dial: (866) 872-0807
State your access code: 53510
Additional information: Caller's name, RID # from OHCA Card and Participant's phone number.

The agent will connect an interpreter.

04/02/2007

OHCA Begins Development of Contingency Plan for NPI Implementation

The Centers for Medicare & Medicaid Services (CMS) has announced that providers can delay full implementation of NPI requirements for electronic claims submission beyond the May 23rd 2007 effective date. In a release dated April 2, 2007 CMS now allows covered entities to develop a contingency plan for full implementation of NPI up to May 23, 2008.

OHCA is in the process of performing a readiness review to determine the appropriate date to implement NPI. The implementation plan will be posted on the OHCA website to assist providers in the transition from SoonerCare ID’s to NPI. You can assist us tremendously by faxing us your NPI to (405) 530-3224 as soon as possible.

If you have any questions please call OHCA Call Center at (800) 522-0114 or (405) 522-6205.

03/22/2007 HMO Co-Pay Claims To assist in the proper payment of HMO co-pay claims, the co-pay amount due should be entered in Block 30 on the 1500 form and Block 55B on the UB-04 form. Please include the EOB or Roster with the corresponding co-pay. HMO co-pays should be filed for fully capitated plans only, not a PPO or Medicare Advantage Plan. These claims must be submitted on paper and mailed to: EDS, PO Box 18500, Oklahoma City, OK 73154.

03/06/2007

To Electronic Batch Submitters – NPI Dual Use Period Companion Documents Now Available

As OHCA previously mentioned, 837 Companion Documents for the Dual Use Period are now available on the OHCA public website at http://www.okhca.org in the Claim Tools area.

Beginning March 19, 2007 through May 22, 2007, the Oklahoma Health Care Authority will accept the National Provider Identifier (NPI) during a Dual Use Period, but will continue to require the SoonerCare-assigned 10-character Provider ID for claims adjudication. While not yet mandatory, healthcare providers who currently have an NPI are encouraged to submit the NPI for the provider information on claims in order to begin preparation for the national implementation of the use of the NPI on May 23, 2007.

If you do not yet have an NPI, you will still be able to submit claims as you currently do with just the SoonerCare-assigned 10-character Provider ID and not use the Dual Use Period Companion Documents. However, we recommend that you apply for an NPI well before the May 23, 2007 deadline in order to continue to submit electronic claims with OHCA after that date.

If you have any questions, please contact the EDS-EDI Help Desk at (405) 416-6801.

02/13/2007

To Electronic Batch Submitters – Dual Use Period for NPI beginning March 19, 2007

Beginning March 19, 2007 through May 22, 2007, the Oklahoma Health Care Authority will accept the National Provider Identifier (NPI) during a Dual Use Period, but will continue to require the SoonerCare-assigned 10-character Provider ID for claims adjudication. While not yet mandatory, healthcare providers who currently have an NPI are encouraged to submit the NPI for the provider information on claims in order to begin preparation for the national implementation of the use of the NPI on May 23, 2007.

Beginning May 23, 2007, the National Provider Identifier must be used as the primary identifier for all healthcare providers. In the 837 Professional, Institutional, and Dental transactions, this identifier will be sent in the NM109 data element in the following loops: 2010AA, 2010AB, 2310A, 2310B, 2310C, 2310D, 2310E, 2420A, 2420B, 2420C, 2420D, 2420E and 2420F*. The upcoming NPI Dual Use Companion Documents will note the appropriate loops for each transaction.

During the Dual Use Period, the tax number formerly used as the primary identifier in the 2010AA and 2010AB loops must be sent in the REF segment of those loops with either an “EI” or “SY” qualifier (for Employer’s Identification Number or Social Security Number, respectively). Also, during the Dual Use period, REF segments with the “1D” qualifier followed by the 10-character SoonerCare Provider ID previously assigned by the Oklahoma Health Care Authority must still be sent in order for claims to be properly adjudicated. REF segments with the “LU” qualifier followed by the ZIP+4 (with no punctuations or blanks) are also encouraged to be sent for the Referring and Rendering Provider loops for Professional and Dental claims, and the Other (Referring) Provider loop for Institutional claims.

837 Companion Documents noting these changes for claims submissions will soon be available. Another global message will follow when the documents have been approved and posted on OHCA’s public website.

If you have any questions, please contact the EDS-EDI Help Desk at (405) 416-6801.

* PLEASE NOTE: Not all of the loops referenced will be present on every transaction.

02/12/2007

NPI Update and Reminder

Please remember to fax your NPI confirmation letter to OHCA Provider Contracting at (405)530-3224, identifying the Legacy number(s) including location code (alpha character at the end) associated with your NPI.

Beginning March 19, 2007 please include your NPI and Legacy ID on your electronic claims. This will allow OHCA time to test claims processing before the May 23rd deadline when claims will process only with the NPI.

Organizations (groups, corporations, clinics, etc.) have the option to obtain separate NPI's for different parts of the business, including different locations, taxonomy or licensure requirements. OHCA recommends that you obtain a separate NPI for each legacy number and location code. This allows us to report payments to you separately for each NPI. For more information, please visit the following website: https://npps.cms.hhs.gov. If you have questions, please call 1-800-522-0114 option 5.

01/29/2007

Dental Administrative Referrals

If you have a member who needs to have a procedure done in a facility, and the PCP cannot provide the H&P because of no facility staff privileges, OHCA will generate an Administrative Referral to a physician to perform the H&P. Please have the provider call 1-877-823-4529, option 2, to request the Administrative Referral.

01/29/2007

#194 Announcing Secure Email

Provider Service is pleased to announce the arrival of secure email. Secure email offers you an alternative to telephone communication. You may find secure email more efficient than dialing into the phone queue for complicated claim issues, policy clarification; request a visit from your provider representative, etc. Secure email will not be an appropriate method to communicate certain activities such as eligibility verification, claim status, changing PCP's, etc.

The new email function is located on the provider secure site (aka Medicaid on the Web). To send a secure email log on to the secure site. Once you have logged on from the menu select Mailbox, then select Send Mail. Enter the subject of your email in the Subject field, and type your email message in the Message Field. When you have completed your email, click the Send button. When you click the send button, your email is on its way. We are not able to do claim status checks but are able to assist in claims process questions. Your request will be answered as quickly as possible based on the information requested. To check for a response to your email, select mailbox, read mail.

We hope you find the secure email function convenient and simple to use. Our goal is to improve communication and service to you. Thank you for the continued support of the SoonerCare program.

01/26/2007

#193 Diagnosis Cross Reference

Effective 1-1-07, all SoonerCare claims must be submitted with a diagnosis code. Along with this change, a Diagnosis Cross Reference is now required. In the Diagnosis Cross Reference field, you will put a "1" if the procedure code refers back to the 1st diagnosis code. If there are 3 diagnosis codes and the procedure refers to all three, use 123 in the diagnosis cross reference field. Failure to include diagnosis cross reference will cause your claim to deny. This is applicable to all types of claim submission including paper, Web, and 837P transactions. In addition, when entering a diagnosis code do not use the decimal if submitting claims through the Web.

01/11/2007

#192 From SC-11, SoonerCare Choice Provider Change Request Form

Beginning January 18, 2007 all SoonerCare Provider Change Request Forms (action forms) must be sent to the SoonerCare Helpline, fax number (405)782-8780, as indicated on the form.

Request Forms which are sent directly to the Oklahoma Health Care Authority will no longer be processed.

01/09/2007

#191 Reminder: Provider Change Request Deadline

SoonerCare Choice Provider Change Request Forms, Form SC-11, must be completed and legible, signed by the member and faxed to the SoonerCare Helpline.

To process the request timely we must receive it before 12:00 noon of the 15th of the month unless this is a weekend or a state holiday. In these cases the request must be received the last working day prior to the 15th.

SoonerCare Helpline - Change Request Forms
Phone: (800)987-7767
FAX: (405)782-8780

10/31/2006 - 06/30/2007

Medicaid on the Web Claims

In the near future, Medicaid providers that submit claims on Medicaid on the Web will no longer need to put in the service dates at the header level. This change is being made to further improve the process of submitting claims on the web. The blocks for the header dates will be grayed out and not accessible. Providers will continue to enter the service dates at the detail level and the system will transfer those dates to the header level. If you have any questions, please contact the Internet Helpdesk: (800)522-0114, Option 2, 1; or in the Oklahoma City area, (405)522-6205, Option 2, 1.

10/27/2006 - 06/30/2007

Valid Diagnosis Code Requirement

Effective 01/01/2007 all claims submitted to the Health Care Authority must include a valid ICD-9 diagnosis code for claim processing. Claims will deny if all necessary information is not included on the claim. If you use a billing company, please make them aware of this requirement.
Thank you for your continued service to SoonerCare members.

10/27/2006 - 06/30/2007

Physician Observation

REMINDER: Since 10/1/2005 observation services (hospital and physician) have been payable under SoonerCare. Observation stays are reviewed for medical necessity and appropriate documentation by our contracted QIO.
Thank you for your continued service to SoonerCare members.

09/28/2006 - 05/31/2007

Important NPI Dates

Please note the timetable below regarding provider NPI numbers.

IMPORTANT DATES & NPI INFORMATION:
10/01/2006: New and renewing contracted providers will be asked to send in their NPI number as part of the contracting process.

10/15/2006: OHCA will accept both the old and new 1500 paper claim form. If the new form is submitted, OHCA requests the NPI be submitted and the legacy provider identification number be provided in the appropriate fields. If the provider is a non-medical provider (a-typical), the legacy provider identification number is required in both ID number fields.

01/01/2007: A) NPIs will be required as part of the contracting process. B) OHCA requests the NPI number and the legacy provider identification number on all 837 transactions.

03/19/2007: Missing NPI edit will post on all 837 and new 1500 paper claims received 3/19/2007 and after.

04/01/2007: Old 1500 paper claim forms received on or after April 1, 2007 will be rejected.

05/23/2007: NPI required on all 837 and NCPDP transactions as well as 1500 paper claims.
Keep watching for important dates about the ADA and 1450 (UB-04).
Update: OHCA will begin accepting the new 1500 claim form on October 15, 2006 rather than the previously stated October 1, 2006.