Budget reductions; policy changes; Provider Training dates; and more!

Budget reductions; policy changes; Provider Training dates; and more!

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Oklahoma Health Care Authority Dental Checkup

Fall 2017

OHCA moving forward with budget reductions

Tighten belt on dollar concept

The Oklahoma Health Care Authority (OHCA) was notified by the Office of Management and Enterprise Services (OMES) on October 2, 2017, that the agency must submit a revised budget by October 10. The new budget must accommodate for the $70 million state funds that were appropriated to the OHCA and lost when the Oklahoma Supreme Court ruled the $1.50/pack smoking cessation fee as unconstitutional.

In order to comply with the OMES request and transparency requirements, the agency has announced potential provider rate reductions should no additional revenues be found. These rate reductions, if approved by the OHCA board, will be effective December 1, 2017.

The agency is proposing a 9 percent across-the-board rate reduction for all providers with a few exceptions, including nursing facilities. This would decrease the physician fee schedule from 86.57 to 78.78 percent of the Medicare fee schedule. Nursing facilities will see a 4 percent rate reduction in addition to the loss of all coinsurance and deductible payments for Medicare Part A and B crossover claims as well as the elimination of reimbursement for therapeutic leave days excluding intermediate care facilities for Individuals with Intellectual Disabilities (ICF-IID).

The smoking-cessation fee accounted for a 7 percent loss of the agency’s base appropriation. Those state funds would have been matched by $105 million in federal funds to contribute toward the agency’s total budget of about $5.6 billion.

“The Oklahoma Health Care Authority continues to work hand-in-hand with the Oklahoma legislature and are optimistic that together we will continue to protect providers from rate reductions,” said OHCA CEO Becky Pasternik-Ikard. “However, we must also answer this request from OMES and provide a worst-case budget scenario.

“We will continue to openly communicate these requirements with providers, the legislature and other stakeholders while reemphasizing that it is our goal to protect the program from further reductions. In the event the agency receives any additional funding this fiscal year, we can revisit these reductions and the budget we plan to file with OMES.”

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OHCA to cease mailing member identification cards

ID Card 2017

Effective November 1, 2017, the OHCA will no longer be mailing plastic member ID cards. This is part of our continuing efforts to be fiscally responsible and reduce paper usage.

This change applies to both SoonerCare and Insure Oklahoma members, as well as children who receive SoonerCare dental benefits under a parent’s Insure Oklahoma Employer-Sponsored Insurance plan.

However, if a physical member ID card is needed, members have the ability to print cards from their Member Portal.  

As an added convenience, providers now have the option to print ID cards from the SoonerCare Provider Portal. To print a member ID card from the Portal, simply:

  1. Select the Eligibility Tab.
  2. Check the member’s eligibility.
  3. Select "Display Member ID Card." 

The button will not display if the member does not currently have eligibility.  

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114.

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Dental Checkup For the record

New dental rule to aid agency budget reductions

Effective Nov. 1, 2017, adult dental services are limited to emergency extractions only. 

At their September meeting, the OHCA Board of Directors voted unanimously to approve rule revisions that clarify dental coverage for adults.

Policy was initially intended to cover "emergency extractions" and was later revised to "medically necessary extractions." The intent of that change was to ensure the emergency extractions were medically necessary; therefore, the policy has reverted back to the original language to include the term "emergency." Adult dental coverage is outlined in OHCA policy 317:30-5-696(1)

Additionally, the latest revisions add new language regarding the medically-necessary images and oral examination that can accompany an emergency extraction.

Budget Impact for the amended policy will result in approximately $479,017 of state share savings for eight months of state fiscal year 2018 (July 1, 2017 - June 30, 2018).  

This proposed rule change (17-14 - Adult Dental Emergency Extractions) posted on the OHCA Policy webpage for a public comment from September 6 - 21, 2017. 

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Proper submission of dental claims adjustments

Two dentists looking at x-ray

Occasionally billing errors occur. The OHCA  finds that the most common dental errors are billing the wrong tooth number or quadrant.

If an error does occur, please do not void a dental claim that is past the six month timely filing deadline. Instead, submit an HCA-15 for an adjustment to a paid claim detail. 

You can download the form on the public website at www.okhca.org/forms.

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Dial your SoonerCare knowledge up a notch!

Training knob pointing to high level

SoonerCare Provider Training Workshops give providers an opportunity to get their questions answered and to learn how to work with SoonerCare better.

Fall sessions cover proper documentation; understanding and correcting claim denials; the ins-and-outs of provider enrollment; and more. Please visit the OHCA Training page  at www.okhca.org/xCourses.aspx for a complete course list and to register for a workshop near you.

We hope to see you at one of the remaining workshops:  

  • Tulsa               October 11 - 12
  • OKC                October 25 - 26
  • Guymon*         November 1

SoonerCare Provider Training Workshops are hosted by OHCA and DXC Technology (formerly Hewlett Packard Enterprise).


*Only PCMH, claim denials, and documentation classes available.

There is additional training available online specific to dental providers.

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OHCA dentist named to distinguished oral health advisory group

Dr. Courtney Barrett, OHCA dentist

OHCA Dentist Dr. Courtney Barrett has been selected as a representative to the Oral Health Technical Advisory Group (OTAG). This group provides Dr. Barrett an opportunity to discuss emerging issues with her peers in other states and to learn about new developments in oral health policy. 

Dr. Barrett represents Region 6, which is comprise of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.

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OHCA hosts 11th annual dental event at Riverside Indian Boarding School

An annual dental evaluation and health screening event co-sponsored by the Oklahoman Health Care Authority (OHCA) at the Riverside Indian Boarding School recently helped about 515 students get dental exams and supplies.

Riverside student Kolten Horschief receives toothpaste from OHCA staff member

Photo: Kolten Horsechief (right), Riverside Indian School student, receives toothpaste from OHCA staff member Johnney Johnson at the annual Riverside Dental event on August 31, 2017.

The OHCA was joined by the Oklahoma State Department of Health (OSDH), Indian Health Services (IHS), Southern Plains Tribal Health Board (SPTHB), Absentee Shawnee Tribe, Little Axe Health Center, and Blue Cross and Blue Shield of Oklahoma (BCBSOK) to sponsor the 11th annual event. New to the list of sponsors this year was the American Heart Association (AHA)

“It’s an honor to work alongside all of these wonderful partners and the Riverside Indian Boarding School staff to help make a positive difference in the lives of these kiddos,” said Dana Miller, OHCA Tribal Government Relations director.

Read more here.

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Tricks of the trade: Top hygiene tips for Halloween

Young girl outdoors in cat costume on Halloween

October is not only time for tricks and treats but it is also National Dental Hygiene Month (NDHM).

Help young boos and ghouls indulge in their sweet spoils and practice good oral health maintenance with five simple tips!

1. Suggest healthy alternatives to candy. 

Sugar-free gum a smart choice for Halloween bags. This gum, which contains the artificial sweetener xylitol, helps fight the bacteria in plaque and the acid that eats away at tooth enamel.

Sugar-free candy is another option. However, try to avoid lollipops and other hard varieties.

2. Recommend limiting the amount of time sugar is in contact with a child’s teeth.

Children should be encouraged to eat only a small amount of candy in one sitting, followed by a glass of water (preferably fluoridated) and thorough tooth brushing. It is not a good idea to allow a child to graze on candy, as this will increase the amount of time sugar is in contact with teeth. 

Happy young boy showing the toothbrush

3. Remind parents that children should eat all foods in moderation.

Although sweets are blamed for much tooth decay, all foods — even healthy alternatives to candy, such as fruit and nuts — can promote tooth decay if eaten in excess.

4. Explain to parents how to set up a candy bank.

Ask parents to allow their child to make daily withdrawals from the bank and monitor the progress. This way, they can control how much candy the child consumes.

5. Take time to brush up on children’s oral health habits.

What better time than now to treat kids to a little reminder about the importance of healthy teeth and gums? Treating them to a new toothbrush and some flavored floss would be a nice touch. Or, how about a sample size of fluoride toothpaste? As a bonus, “treats” like these set children up for healthier dental habits just in time for the holidays.

Promoting good oral health doesn’t have to be scary this time of year!

Start the conversation about fresh breath, strong teeth and healthy gums! The American Dental Hygienist Association (ADHA) encourages everyone to BRUSH twice a day, FLOSS regularly, RINSE with mouthwash, and CHEW sugar-free gum after meals for a lifetime of smiles.


Information adapted from the Academy of General Dentistry

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Dental Checkup Provider Toolkit

OHCA Provider Helpline: 800-522-0114

Dental Prior Authorization Unit: 405-522-7401

Provider Resources

Web Alerts

Online Training

Dental Checkup Statement

Information contained within is subject to change. Be sure to check OHCA Provider LettersGlobal Messages and Web Alerts at okhca.org for the most up-to-date information.

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**Editor’s note: The opinions in these articles are those of the author(s) and do not necessarily represent the views of SoonerCare Dental or the Oklahoma Health Care Authority.

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    Answers to your frequently asked questions

    1.    What can you tell me about SoonerCare provider contract renewals?

    Answer: All SoonerCare contracts for groups end Nov. 30, 2017. Individual dental provider contracts were due September 30.

    We encourage you to start the re-enrollment process as soon as possible through the secure OHCA Provider Portal.

    2.    When is it appropriate to bill for a comprehensive oral evaluation? 

    Answer: D0150 (comprehensive oral evaluation) may be used ONLY if the member has not been seen by ANY dentist within the past three years.

    Agency closings

     The OHCA would like to announce our holiday schedule for the period November 2017 through January 2018. 

    • Nov. 10, 2017 – Veterans Day
    • Nov. 23-24, 2017 – Thanksgiving Holiday
    • Dec. 25-26, 2017 – Christmas Holiday
    • Jan. 1, 2018 – New Year’s Day
    • Jan. 15, 2018 – Martin Luther King, Jr. Day

    Thank you for understanding.

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