Increased provider rates approved at the Oklahoma Capitol

Legislative update; PA changes; important policy reminders; NEW contract fees and much more!

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Spring 2018, Vol. 2

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Increased provider rates among legislation approved at the Capitol

State budget issues continue to impact operations at the Oklahoma Health Care Authority

Legislative Updates

Sine Die Adjournment
The 56th Legislature adjourned sine die on May 3, 2018. The governor has 15 days – through May 18 – to sign or veto bills passed in the final week of session. After sine die, bills that are not signed by the governor are considered vetoed.

State Fiscal Year 2019 Appropriations
SB 1600, which makes appropriations to state agencies for the upcoming fiscal year, was signed by the governor on April 30. The Oklahoma Health Care Authority (OHCA) state fiscal year appropriations total $1.13 billion.

Work Requirements
Gov. Fallin issued a work requirements executive order (EO) on March 5 to direct OHCA to develop recommendations for a Medicaid work requirements program. OHCA will provide recommendations to the governor and Legislature within six months of the EO.

In addition to the governor’s EO, the following companion legislation was passed:

  • HB 2932 – Directs OHCA to seek a work requirements waiver and specifies program criteria. (Signed by governor, May 7, 2018)

Other OHCA Legislation

  • SB 972 – Requires OHCA to examine the feasibility of a state plan amendment for diabetes self-management training. (Governor signed, April 12, 2018)
  • SB 1053 –Authorizes Oklahoma Department of Veterans Affairs to obtain certification through the federal Centers for Medicare & Medicaid Services (CMS) and accept payments/reimbursements from Medicare and Medicaid programs for services provided through Oklahoma veterans centers. (Governor signed, April 24, 2018)
  • SB 1591 – Provides authority for OHCA to establish a supplemental reimbursement program for certain ground emergency medical transportation services. (Signed by governor, May 8, 2018)
  • SB 1605 – Directs OHCA to increase provider reimbursement rates and provides other legislative direction for SFY19. (Signed by governor, May 10, 2018)

Upcoming Dates
The 57th Legislature will convene Jan. 8, 2019, at noon and recess no later than 5 p.m. the same day. The governor’s state address will be Monday, Feb. 4, 2019, at noon.

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Electronic visit verification coming for some Medicaid services

Illustration of a blue stethoscope wrapped around tiny house

 A new federal law mandates electronic visit verification (EVV) for home health care services requiring an in-home visit that are covered under a state plan or under a waiver of the plan. Implementation will begin on Jan. 1, 2019, for personal care services and Jan. 1, 2023, for home health services.

In obligation to the Oklahoma Open Meeting Act, the OHCA will host stakeholder meetings to include input from members, family caregivers and individuals who furnish personal care services or home health services.

The first stakeholder meeting will take place at the Health Care Authority (4345 N. Lincoln Blvd., OKC) on June 13, 2018, at 9:30 am. A second stakeholder meeting will be held in Tulsa, OK, on July 11. The time and location of the Tulsa meeting will be announced in the near future. 

Please refer to our website ( for more information and to register for the events.

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Provider Notes

Contract renewals

Provider enrollment and renewal application fees

 As a reminder, institutional providers are responsible for application fees at the time of new and renewal enrollments. These fees are a federal requirement that went into effect  Jan. 1, 2018. A list of provider types subject to these fees is available in Provider Letter 2018-05.

Furthermore, providers can visit the Provider Enrollment webpage to find renewal dates. They can be found under Contract Types.

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Policy and programs

Virtual visits

The OHCA is always looking for ways to improve access to care. We are also very aware of the advancement in technology related to telehealth, or virtual visits. As such, we have a list of codes available on our website that providers can bill when providing care to members through virtual visits.

The five codes associated with telehealth visits for primary care are 99201, 99211, 99212, 99444 and 98969. A complete listing of applicable codes is available on the OHCA Telehealth webpage. More telehealth details are available in OHCA policy at OAC 317:30-3-27.

Have questions? Please contact the OHCA Provider Helpline: 800-522-0114.

Female doctor gives toddler girl an injection


Regarding childhood vaccinations

Providing childhood immunizations is a requirement of our SoonerCare primary care physicians (PCPs). 

As per Oklahoma Administrative Code (OAC) 317:30-5-1155, enrollment in the Vaccines for Children (VFC)  program is no longer a condition of contracting for SoonerCare Choice (patient-centered medical home) providers; however, all SoonerCare PCPs maintain the responsibility of providing immunizations for children assigned to their panel. Providers should administer immunizations in accordance with the Centers for Disease Control Advisory Committee on Immunizations Practices.

For your convenience, a variety of printer-friendly immunization schedules is available on the OHCA public site. This includes a Spanish version.

To access the full scope of OHCA’s policies and rules for the SoonerCare program, please visit You can access the policy for the EPDST screening criteria at OAC 317:30-3-65.

We strongly encourage providers who have assigned pediatric patients to contact the Oklahoma State Department of Health (OSDH) to discuss enrollment in the VFC program. Information is also available on the OSDH website.


Additional resource:

Oklahoma State Department of Health. Immunizations: Information for health professionals.,_Prevention,_Preparedness/Immunizations/Information_for_Health_Professionals/index.html

Copays for SoonerCare members: Exempt groups

SoonerCare members are responsible for paying all applicable copay amounts; however, certain groups are exempt from copays. The OHCA does not require copays for:

  • Children (less than age 21).
  • Certain American Indians and Alaskan Natives.
  • Persons residing in an institution.
  • Persons receiving hospice care.
  • Persons in the Oklahoma Cares (breast and cervical cancer treatment) Program.
  • Persons served in home and community-based services waivers with the exception of prescription drugs.

Furthermore, certain SoonerCare benefits are also exempt from copays, including some services provided to pregnant women. Full cost sharing details are available at under OAC 317:30-3-1-5.

Providers should use the electronic verification system (EVS) to not only check eligibility but also to determine if the member has a copay.

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Provider services

Portrait of a female doctor using a computer

Changes to the PA process for medical providers

Effective June 4, 2018, the OHCA will embed InterQual® evidence-based questions and answers for certain imaging and pain management prior authorization (PA) requests into the SoonerCare Provider Portal PA function. This is the second phase of our InterQual® implementation, as previously described in Provider Letter 2017-35. 

The transition will take place during the next 12 months and will include most medical PA requests*.

Also effective June 4, 2018, the OHCA will implement near real-time adjudication (15 minutes or less) for certain imaging study PAs. To accomplish this, imaging PAs will require electronic attachments upon submission that support the PA request.

The InterQual® process and adjudication changes will be covered in the spring Provider Training events being held in May and June. We encourage all medical providers to sign up for a training session near them in order to prepare for these upcoming changes. You can sign up on the OHCA Training webpage.

If you have any questions about these PA process changes or the InterQual® implementation, please call the OHCA Provider Helpline at 800-522-0114.  

* As a reminder: Approved PAs are not a guarantee of payment due to a variety of reasons (such as eligibility, etc.).


About member ID cards

The OHCA no longer issues member ID cards. This is part of our continuing efforts to be fiscally responsible and reduce paper usage. The change went into effect Nov. 1, 2017.  

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

As an added convenience, providers also have the option to print ID cards from the SoonerCare Provider Portal. To do so, simply log on and select the Eligibility Tab, verify the member’s eligibility, and then select “Display Member ID Card.”  If the member does not currently have eligibility, this button will not display.

If you have any questions about this new process, please call the OHCA Provider Helpline at 800-522-0114.

Pain Management Toolkit Update

The SoonerCare Pain Management Program is a program designed to equip SoonerCare providers with the knowledge and skills to appropriately treat members with chronic pain. To accomplish this, the OHCA has developed a proper prescribing toolkit. An electronic version of the toolkit can be accessed from our website.

The Pain Management Toolkit underwent an update in March 2018. We encourage providers to download and use the most current iteration.

To learn more about the SoonerCare Pain Management Program, please visit

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“P” is for Pharmacy and … 

Prenatal Vitamins 

The Oklahoma Health Care Authority (OHCA) highlighted the importance of prenatal vitamins in a recent letter to SoonerCare providers.

Open bottle of vitamins spills contents

In 2017, only 61 percent of SoonerCare members received a prescribed prenatal vitamin while pregnant. That number falls well short of the recent March of Dimes survey indicating 97 percent of women nationally received a prenatal vitamin or multivitamin during their current or last pregnancy. The March of Dimes survey also points to the importance of health care providers as the primary source of pregnancy education. The survey reported 92 percent of women taking prenatal vitamins were acting upon a specific recommendation from their health care provider.

SoonerCare providers are uniquely positioned to have a significant positive impact on prenatal care for our members! A current list of prenatal vitamins available without prior authorization is available at These preferred vitamins may require prescription but do not require a copay.


May is National Preeclampsia Awareness Month. The Preeclampsia Foundation has provided free resources for patients at risk for preeclampsia and for those who have already experienced preeclampsia.

The United States Preventive Services Task Force recommends use of low-dose (81mg) aspirin, after 12 weeks gestation, for patients at high risk of developing preeclampsia. The American College of Obstetricians and Gynecologists offers complete treatment and prevention guidelines on its website.

Read about two more P's: Past-date Insulin and Prior Authorizations, in the complete article on our Pharmacy webpage. 

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One simple step to improve prenatal care

Doctor giving pregnant patient an ultrasound

The OHCA is engaged in an effort to improve the quality of prenatal care for our members. A recent review of pharmacy claims between 2012 and 2017 showed the following:

  • The percentage of members utilizing a prenatal vitamin has dropped from 76 percent to 61 percent.
  • Most pregnant members only had two paid claims for prenatal vitamins.

The goal is to improve the utilization of prenatal vitamins in pregnant members receiving SoonerCare services. Maternal nutrition, including adequate vitamin and mineral intake before and during pregnancy, can improve the chances of having a healthy pregnancy.

It is important that providers note the following regarding coverage of prenatal vitamins:

  • Preferred prenatal vitamins do not require a prior authorization.
  • All preferred prenatal vitamins have a $0 copay when filled as a prescription.

Help your patients have the healthiest pregnancies possible - prescribe prenatal vitamins and encourage their use!

Updated versions of the preferred prenatal vitamin list are always available on our Pharmacy webpage:*

More details are available in Provider Letter 2018-08. If you have any questions, please contact the Pharmacy Help Desk at 800-522-0114, option 4.


*This list may change from time to time based on market conditions.

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Insure Oklahoma

IO Logo

Specialists and hospitals that are contracted with OHCA to see TXIX and SoonerCare members can also see Insure Oklahoma Individual Plan (IP) members without any additional contracting

Insure Oklahoma IP is a managed care program in which members have a primary care provider (PCP) and obtain referrals for most services. When checking eligibility, Insure Oklahoma IP members will show as PUB.

As a provider of service to these members, providers receive 100 percent of the SoonerCare allowable for covered services plus any applicable copay. Copays range from $4 for an office visit to $50 for an inpatient hospital admission. 

The processes for checking eligibility, submitting claims, referrals and prior authorization are the same as for the SoonerCare program.

Have questions? Please contact the OHCA Provider Helpline at 800-522-0114.

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New on

Hupfeld appointed to the OHCA Board

Stan Hupfeld, OHCA Board Member

Gov. Mary Fallin recently appointed Stanley F. Hupfeld, of Oklahoma City, to the OHCA Board.

Hupfeld currently serves as senior consultant of INTEGRIS Health following a career with the health care system that spans more than 30 years. He became President and Chief Executive Officer of Oklahoma Healthcare Corporation and its subsidiaries, including Baptist Medical Center of Oklahoma, on March 30, 1987.  In 1995, he led the merger of Baptist Medical Center, Southwest Medical Center, and Baptist Healthcare of Oklahoma to form INTEGRIS Health, an integrated delivery system comprising 13 hospitals, all in Oklahoma.  After 23 years as President and Chief Executive Officer of INTEGRIS Health, Hupfeld transitioned January 2010 to Chairman of the INTEGRIS Family of Foundations then into his current position.

“Mr. Hupfeld brings a wealth of health care experience to this appointment," said OHCA CEO Becky Pasternik-Ikard. "We’re excited to have him join our board and look forward to working together for our SoonerCare and Insure Oklahoma programs.”

Read more.

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About us: SoonerCare basics 

The OHCA has made available new resources that focus on the fundamentals of SoonerCare. 

A series of one-page handouts highlights the basics of eligibility and member enrollment, as well as provider enrollment and provider audits, among others. These materials are available on the OHCA public website for your convenience.

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Cover of the state fiscal year (SFY) 2018 - SFY 2022 OHCA Strategic Plan  

Strategic Plan now online!

Take a look into the future with our newly-released five-year Strategic Plan and learn how you can be a part of progressive health care in Oklahoma.

Visit to download a PDF of this report and check out other agency studies, evaluations and more.

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Same great content, brand new look!

Spring always brings about a refreshing change of scenery, and that sentiment is reflected in this issue of the Provider Checkup. We hope you enjoy our makeover!

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The Oklahoma Tobacco Helpline's "5 Keys to Patient Success"

Female health care provider talks about the Tobacco Helpline with patient in waiting room

Providers can play a huge role in helping their SoonerCare patients quit tobacco. The knowledge and tobacco cessation benefits you provide, combined with the valuable resources available through the Oklahoma Tobacco Helpline (OTH), can help patients find success on their journey to being tobacco free.

Encourage your patients to utilize FREE OTH services, including free text and email support, phone and web coaching, and patches, gum or lozenges. SoonerCare patients may also receive additional tobacco cessation products, as well as counseling and over-the-counter medications.

Don’t know where to start this discussion with your patients? Try approaching the subject by discussing the Helpline’s "5 Keys to Patient Success," available for download on our Tobacco Cessation Benefit webpage, under SoonerCare Resources.

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Provider Toolkit

OHCA Provider Helpline: 800-522-0114


Provider Resources

Web Alerts

Online Training


Order Publications

Statistics and Data

Newsletter Archive

Checkup Statement

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

Appointment Reminders


June 13
Drug Utilization Review (DUR) Board Meeting

June 28
OHCA Board Meeting

July 3
Tribal Consultation

View complete OHCA calendar here

Holiday schedule: Agency closures

Please note: Monday, May 28 and Wednesday, July 4 are state holidays, and our agency will be closed. We assure you that any concerns you may have will be addressed during normal business hours.

Thank you.

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