Behavioral Health Services
Basic Primary and Preventive Services
A basic package of primary and preventive behavioral services, such as screenings for depression, anxiety and substance abuse is available to every SoonerCare member without prior authorization for services delivered by a Patient-Centered Medical Homes, Indian/Tribal/Urban (I/T/U) Clinics, and Federally Qualified Health Centers. Other specialty providers, (i.e., public and private outpatient behavioral health agencies, and private independent licensed practitioners) must complete preadmission forms.
Education and Billing
Fee Schedules/Getting Paid
Inpatient Hospital and Residential Services
Inpatient Hospital and Residential services for SoonerCare members under the age of 21 must be prior authorized before the service is provided. Telephonic initial and concurrent reviews to determine Medical Necessity Criteria (Manual) are required for the following services:
Preadmission and Level of Care Services
Public and private outpatient behavioral health agencies, and private independent licensed practitioners must complete the Customer Data Core (CDC) Form and submit to the OHCA designated behavioral health utilization management and quality improvement organization. Currently this information must be submitted via the PI Client Information System. The information provided for pre-admission is brief and is primarily used to track the utilization of various services.
Preadmission services do not require clinical review and will be approved unless the member has exhausted the benefit or another provider has requested prior authorization for additional services.
Prior Authorization Requests
Prior authorization is required for members who require service intensity or duration beyond the pre-admission level.
Prescription Medication Guidelines
Reports and Evaluations, Outcomes
On the OHCA proposed rule changes page, there is a sign up button for Web Alerts.
These Web 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.
Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.