Fall 2019 Provider Workshop

Adjustments and Third Party Liability

Recommended Audience: All SoonerCare provider types and billing staff.

Description: This class will cover when and why adjustments are required, as well as instructions on requesting an adjustment for all claim types. The class will also cover Third Party Liability (TPL) topics, including how OHCA verifies a member’s TPL, HMO Copayments, Medicare replacements and supplements. Forms to be covered in this class:  HCA-13, HCA-14, HCA-15, Pharm3 and TPL1.

Presentation: Adjustments TPL

Dental Basics and Beyond

Recommended Audience: General Dentists, Orthodontists and Administrative Staff.

Description: A current look at covered services, covered populations, prior authorization and claim submissions within the SoonerCare Provider Portal.

Presentation: Dental

HMS: Medicaid Third Party Liability – Disallowance Overview

Recommended Audience: Medical, dental and hospital providers who currently receive disallowance billings and requests from HMS.

Description: This class covers the commercial insurance, Medicare (Part A) and Medicare (Part B) disallowance process and the impact of TPL on OHCA providers—the nuts and bolts of disallowance billing and the recoupment process. (Please note: HMS will be available for Q&A in Oklahoma City and Tulsa locations only).

Presentation: HMS TPL

Lead Poisoning Prevention 101

Recommended Audience: Providers and groups that work with small children (under age 6).

Description: All children are required to have blood lead testing at 12 months and 24 months. This class focuses on the importance of obtaining blood lead test screenings, the type of follow-up required for children, and important information to give to parents. We also provide an opportunity for providers to ask questions concerning the Oklahoma Childhood Lead Poisoning Prevention Program (OCLPPP).

Presentation: Lead Poisoning

Long Term Care Pay for Performance

Recommended Audience: Long Term Care Nursing Facilities who participated in the FOE program or those who wish to participate in the new program.

Description: This class will cover the new Quality Improvement Program that is replacing the Focus on Excellence (FOE) program. We will cover the four new quality measures included in the recently passed Senate Bill 280 and a brief overview of how these quality measures will be calculated for payment.

Presentation: Long Term Care

SoonerCare Changes and Updates

Recommended Audience: All SoonerCare and Insure Oklahoma providers.

Description: This class will cover the many changes and updates within the SoonerCare program. Some of these will include the “Oklahoma Residency Verification Process”, telehealth services, maternal depression screenings, vaccines for children and other subjects.

Presentation: SC Updates

SoonerCare Pharmacy Program Updates

Recommended Audience: The target audience will be providers/prescribers and pharmacy personnel.

Description: This class will supply providers with a high level overview of the OHCA pharmacy program. The presentation will have an emphasis on prescription drug abuse in the state, morphine milligram equivalent (MME), and medication assisted treatment (MAT) changes. In addition, the prior authorization process, drug rebate program, and other pharmacy initiatives will be discussed.

Presentation: SC Pharmacy

SoonerQuit for Providers

Recommended Audience: Practitioners, case managers, care coordinators.

Description: This class will discuss the Tobacco Cessation billing components, referrals to the Oklahoma Tobacco Helpline and the SoonerQuit Practice Facilitation program.

Presentation: SoonerQuit

Utilizing Your Provider Portal

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

Description: This class will provide instruction on how to optimize certain areas of the provider portal. We will discuss how to access, understand and utilize important tools such as updating provider file, clerk creation, admin rights and additional features.

Presentation: Provider Portal

What’s New in Out of State Services?

Recommended Audience: All providers who may request out-of-state services (MD, DO, APRN, PA), or specialists to whom referrals may be made to evaluate for out-of-state services.

Description: Important changes in federal regulations and state rules have resulted in SoonerCare policy modifications for out-of-state services. All three types of existing out-of-state services will be reviewed and new changes will be presented.

Presentation: OOS Services

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