Global Messages

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2006 Global Messages 

 

 Date Posted Title
 Message  
5/30/2019 RE: Change in Billing for Supprelin® LA As authorized by OAC 317:30-5-77.2, effective July 1, 2019, the Oklahoma Health Care Authority (OHCA) will change the way Supprelin® LA for central precocious puberty is billed.

Supprelin® LA is only available through the medical benefit. The current billing code used is J9226. This code may change in the future based on guidance from the Centers for Medicare and Medicaid Services (CMS). It is the provider’s responsibility to assure codes used for billing are up to date and accurate.

Supprelin® LA continues to require a prior authorization (PA). The specific PA requirements for Supprelin® LA are below and can be located on the OHCA website at www.okhca.org/pa in the “Diabetes/Endocrine” therapeutic category. Use the PA form PHARM-18, which can be found on the OHCA website at www.okhca.org/rxforms.

An FDA approved diagnosis of central precocious puberty is confirmed by submitting the following:

  • Documentation of onset of symptoms <8 years of age in females and 9 years of age in males; AND
  • Documentation that bone age is advanced 1 year beyond the chronological age; AND
  • Lab assessment:
    • Documentation of abnormal basal gonadotropin levels; OR
    • Documentation of pubertal response to a gonadotropin-releasing hormone analog stimulation test; AND
     
  • Approvals may be granted with documentation of failed trials of lower-tiered products or an FDA approved indication not covered by a lower-tiered product, such as Lupron Depot-Ped® and Triptodur®.  

All medication PA requests are submitted to the Pharmacy Prior Authorization Unit at the fax number located at the bottom of the form. Do not submit the request to Medical Authorization Unit or via the provider portal.

If you have questions, please contact the Pharmacy Authorization Unit at (800) 522-0114, option 4.

5/23/2019
Coverage of Direct Resin-based Composite Restorations

Provider type: 27, Provider Specialty: 086, 271, 274, 278

Effective May 20, 2019, dental services for children will include coverage of CDT code D2394, resin-based composite- four or more surfaces, posterior.

For utilization parameters and coverage criteria for restorations, see OAC 317:30-5-699.

Payment is made for dental services set forth in this section.
5/8/2019 Information On The Appropriate Use of Modifiers

The Oklahoma Health Care Authority (OHCA) is providing the following links as a resource to assist Providers in the billing and use of appropriate modifiers, specifically modifiers 25 and 59. 

Novitas Modifier 25

Novitas Modifier 59

5/1/2019 Prostatic Urethral Lift Effective 05/01/2019, the Oklahoma Health Care Authority (OHCA) implemented coverage for the following codes for the Prostatic Urethral Lift:
  • 52441 – UroLift cystourethroscope first implant
  • 52442 – UroLift cystourethroscope each additional implant
The UroLift system is a minimally invasive treatment for benign prostatic enlargement with lower urinary tract symptoms.

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have any questions about this new coverage.
4/17/2019 C-Section Rate Letters

C-section rate letters, for the second quarter of state fiscal year 2019, are now available through the OHCA Provider Portal. As a reminder, these C-section letters are only available electronically.    

If you need help retrieving your letters, please call the Provider Helpline at 800-522-0114 for questions concerning the Portal.     

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

Thank you.

3/6/2019 Skin Substitute Coverage Effective 02/15/2019, the Oklahoma Health Care Authority (OHCA) implemented coverage for the following skin substitute products:
  • Q4102—Oasis Wound Matrix
  • Q4107—Graftjacket
  • Q4132—Grafix Core
  • Q4133—Grafix Prime
  • Q4186—Epifix  

Skin substitute products will require prior authorization (PA) along with documentation supporting medical necessity (as outlined in the Oklahoma Administrative Code (OAC) 317:30-3-1). For your review, OHCA’s Wound Care and Skin Substitute guidelines are posted on our website under Medical Authorization Unit which outline specific indicators for use.

The OHCA expects that in cases in which there are multiple sizes of products available, the size that best fits the wound with the least amount of waste, at the LESSER cost, will be utilized.

Please call the OHCA Provider Helpline at 1-800-522-0114 if you have any questions about this new coverage.

2/14/2019 CPT 87150 Reimbursement Change

Title: CPT 87150 Reimbursement Change

Effective February 15, 2019, the Oklahoma Health Care Authority (OHCA) will only reimburse for CPT 87150 (culture typing; identification by nucleic acid [DNA or RNA] probe, amplified probe technique, per culture or isolate, each organism probed) in the outpatient hospital setting. 

Please note: When this service is performed in the inpatient setting, reimbursement is included in the DRG payment. 

If you have questions about this change, please contact the OHCA Provider Helpline at 1-800-522-0114.

2/12/2019 Electronic Inpatient and Discharge Notifications

Title: Electronic Inpatient and Discharge Notifications

Inpatient admission and discharge letters are now available on the SoonerCare Provider Portal. You can find them under the Letters tab. Previously faxed, the inpatient admission and discharge letters are now only available electronically. This change only affects PCMH providers.

1/25/2019 Dear Provider Letter 2019-01

Title: Dear Provider Letter 2019-01

Provider Letter 2019-01 serves to inform providers about policy regarding laboratory and diagnostic testing. Please post all comments by close of business Monday, February 24, 2019, via the Oklahoma Health Care Authority Policy Change Blog.  Thank you.

1/22/2019 Vaccine Administration Documentation

TITLE: Vaccine Administration Documentation

The Oklahoma Health Care Authority routinely reviews medical records in association with other business processes. The reviewers have noticed a lack of required information pertaining to vaccine administration and would like to remind providers of the required medical record documentation as per the CDC and ACIP recommendations. This information can be found at https://www.cdc.gov/vaccines/pubs/pinkbook/vac-admin.html#documentation 

All vaccines administered should be fully documented in the patient’s permanent medical record. As per the requirements of the National Childhood Vaccine Injury Act and best practice, documentation should include the following:

  • date of administration
  • vaccine manufacturer
  • vaccine lot number
  • name and title of person who administered vaccine and address of facility where permanent record will reside
  • vaccine information statement (VIS)
  • date on VIS
  • date provided to patient or parent/guardian
  • vaccine type (ACIP abbreviation)
  • route
  • dosage (volume)
  • site
  • document vaccine refusal

Please contact the OHCA Provider Helpline at 1-800-522-0114 with any questions or concerns.

1/17/2019 C-Section Rates Letters

  TITLE: C-Section Rates Letters

C-section rate letters for the first quarter of state fiscal year 2019 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,for the Provider Helpline. Choose option 1 for questions concerning the Portal. 

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

Thank you.