Spring 2019 Provider Workshop

1915(c) Home and Community Based Services

Recommended Audience: Providers billing for targeted case management, DME, personal care & home health.

Description: This class will focus on the various home and community programs that would either allow members to transition from a long-term care institution and back into the community or remain in their own homes with a medically fragile condition.  I plan to discuss the new federal mandate of implementing an electronic visit verification and timelines for the 2019 implementation.

Presentation: Home and Community

Advanced Claim Denials

Recommended Audience: Billing staff for all provider types.

Description: The Advanced Claim Denials class will take an in-depth look at claim denials for 1500, UB04 and Dental claims on the Provider Portal as well as on a paper remittance advice. Providers will be shown how to read claim denials and the steps needed to correct those denials to achieve a successful resubmission of a denied claim.

Presentation: Claim Denials

Insure Oklahoma 101

Recommended Audience: All SoonerCare Providers

Description: Insure Oklahoma's Employer Sponsored Insurance plan helps employers provide their eligible employees with affordable health care. Eligible individuals may also participate in the Insure Oklahoma Individual Plan to have affordable health care.

Presentation: Insure Oklahoma

Patient-Centered Medical Home Updates and Reminders

Recommended Audience: Existing SoonerCare Choice primary care providers/medical homes and those interested in becoming a medical home provider.

Description: This class will cover recent updates to processes affecting SoonerCare Medical Home providers, contract reminders and tier requirements.

Presentation: Medical Home

Promoting Literacy in the Well-Child Visit through Reach Out and Read: An AAP-Recommended Standard P

Recommended Audience: Medical Providers and Staff

Description: Reach Out and Read (ROR), an evidence-based, early childhood literacy intervention, gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together. This session will introduce ROR, present the supporting research evidence, describe how literacy promotion is smoothly integrated into well-child visits, and provide the steps for clinics on becoming a Reach Out and Read partnering site.

Presentation: Reach Out and Read

Provider Contracting Essentials

Recommended Audience: Providers, Credentialing/Enrollment Agents, Administrators and Office Managers.

Description: This course will offer essential solutions to the most common contracting issues for all provider types. It will include tools and resources to successfully update and maintain your provider’s file and contract through the SoonerCare Provider Portal. 

Presentation: Contract Essentials

SoonerCare Referrals

Recommended Audience: All Patient Centered Medical Homes who issue referrals and specialists who receive referrals.

Description: This class will provide instructions as to what information is required for referrals issued by a Patient Centered Medical Home provider and provide resolution to common issues surrounding referrals.

Presentation: SC Referrals

SoonerCare Tools of the Trade

Recommended Audience: Office staff for all provider types, including front desk and billing staff.

Description: The goal of this class is to make certain that all providers are properly submitting claims to SoonerCare.  We will cover different areas of claims submission and how to access, understand and utilize different tools that are available to Providers. We will discuss eligibility, treatment history, provider reports, prior authorization determination, and faxing amendment documentation.  In addition, the correct submission methods of paper claims for 1500, UB04 and Dental will be reviewed.

Presentation: SC Tools of the Trade

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