A valid Oklahoma mailing address is required for all SoonerCare members.

During their office visits, please encourage members to update any changes to their address through the SoonerCare Member Portal (www.mySoonerCare.org). The process takes less than five minutes and helps to prevent interruption of their benefits. You can even download or order our new flyer (one side in English, one side in Spanish) to distribute in your office.

Members can also update their contact information by calling the SoonerCare Helpline at 1-800-987-7767.

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Keeping your office abreast of current dental codes and billing practices is part of ensuring that your patients’ health is tracked accurately. The Code on Dental Procedures and Nomenclature (CDT) is reviewed and revised each year – new codes are developed, and old and/or unused codes go obsolete. The Council on Dental Benefit Programs (CDBP) is responsible for CDT Code maintenance.

Following any CDT updates, the OHCA may make changes to the CDT codes covered by SoonerCare. Providers should read OHCA Provider Letters, Global Messages and other agency communications regarding changes to covered services.

Furthermore, to avoid confusion and inefficient billing, it is recommended that dental staff have a copy of the most current CDT manual available to them.

Below are some of the most recent CDT updates. This list is for informational purposes only and may not be all-inclusive:

• D1516 Maxillary, D1517 Mandibular (replaces code D1515) - Changed
• D1526 Maxillary, D1527 Mandibular (replaces code D1525) - Changed
• D5282 Maxillary, D5283 Mandibular (replaces code D5281) - Changed
• D9130: Temporomandibular Joint Dysfunction - New
• D9944 Hard Appliance,D9945 Soft Appliance, D9946 Hard Partial Arch (replaces D9940) - Changed

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April is Oral Cancer Awareness Month

According to Oral Cancer Foundation, one person every hour of the day will die from complications of oral cancer. OHCA encourages our providers to increase oral cancer awareness by speaking with patients about the risk factors for oral cancer, as well as the importance of early detection and prevention.

Though preventable and not as common as other cancers, oral cancer is particularly dangerous because in its early stages it may go undetected by the patient and can progress without pain or symptoms. The higher death rate associated with oral cancer is often as a result of the cancer being diagnosed late in its development. Oral cancer is frequently found after the cancer has metastasized to another location, most likely the lymph nodes of the neck. The survival rate for a localized diagnosis is more than twice as high as a metastasized cancer diagnosis, hence the importance of early detection. Patients who survive a first encounter with oral cancer have a higher risk of developing a second cancer – this increased risk factor can last for five to 10 years after the first occurrence.

Tobacco is single biggest risk factor for oral cancer and is responsible for most resulting deaths. The synergistic effect of tobacco usage and excessive alcohol consumption is another leading risk factor for oral cancer. Those at an especially high risk of developing oral cancer are men older than age 50 who are heavy drinkers and smokers. Chewing betel quid, excessive sun exposure, and consuming a poor diet may also contribute to the chances of developing oral cancer.

The leading cause of oropharyngeal cancer is human papillomavirus (HPV). HPV is the most common sexually transmitted disease in the United States. There are more than 100 strains of HPV, however, only nine are associated with cancers, and only HPV-16 is strongly associated with oropharyngeal cancer.

Oral sex has been identified as the primary mechanism of oral colonization of HPV-16 and is related to the increasing incidence of mouth cancer in younger, non-smoking patients. There is a lower incidence of death with HPV-positive oropharyngeal cancers, though they typically develop in the throat at the base of the tongue and in the folds of the tonsils making them difficult to detect.

It is recommended that adolescents get the HPV vaccine at age 11 or 12, regardless of whether or not they are sexually active. The HPV vaccine is most effective when given before age 13, but vaccination may be provided up to age 26. SoonerCare covers the HPV vaccine under guidelines established by the Advisory Committee on Immunization Practices (ACIP) for children and adults.

Patients should be reminded to see their dentist for any sore, irritation, discoloration, erosion, lump or thickening of tissue which does not resolve within a two-week period. Any change in the way teeth fit together, difficulty chewing, speaking, swallowing, numbness, or hoarseness lasting longer than two weeks should be considered suspect and worthy of further examination or referral.

Providers can get involved by educating patients and their families about oral cancer – discuss the risks and promote prevention:

• Host an oral cancer screening event, promote oral cancer awareness in your office and on your website.
• Refer patients to their dentist for regular exams and oral cancer screenings, as early diagnosis is key to treating oral cancer.
• Encourage patients to visit their primary care provider for HPV vaccinations; those without a PCP may contact the local health department.
• Encourage patients to limit alcohol and avoid smoking and tobacco products.

The Oklahoma Tobacco Helpline (1-800-Quit-Now) is a free service available 24/7 that provides support for those wanting to quit tobacco habits. In addition, SoonerCare members have a tobacco cessation counseling benefit that can be utilized for direct care from medical and dental providers. With your support we can continue to decrease the incidence of oral cancer.

For more information about oral cancer, its diagnosis and treatment, visit the Oral Cancer Foundation website.

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Insure Oklahoma (IO) helps more Oklahomans gain access to health care coverage. There are two different IO programs that may assist both your employees and your patients: Employer-Sponsored Insurance (ESI) and the Individual Plan (IP).

ESI helps businesses with 250 or fewer employees to provide commercial health insurance through premium assistance. Insure Oklahoma can also support nonprofit organizations of 500 or fewer employees. Qualified employers can save at least 60 percent on a qualified employee’s health insurance premium. Additionally, Insure Oklahoma assists with premium costs for qualified dependents.

IP may help those who do not have health coverage through their employer.

For complete IO eligibility and program requirements, please visit insureoklahoma.org.

Meet the team!

IO is a great program, and we want everyone to know about it. Our new outreach team is helping to accomplish that!

The Oklahoma Mission of Mercy (OKMOM) is a two-day, free dental clinic offering treatment to patients who are either uninsured, under-insured or would normally not have access to dental care. The 2019 OKMOM event, which marks its 10th year, was held February 1 and 2 in OKC.

According to the OKMOM Facebook page:

• 1,684 patients were treated
• $1,512,266 in treatment were donated
• $898 was the average amount of treatment per patient
• 1,970 volunteers helped to make the event a success (this includes members of the OHCA Dental Unit)

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1. Is it possible for a SoonerCare member to also have private insurance?

Yes. If a member has third-party insurance, SoonerCare is the payer of last resort in most circumstances.

2. What information are health insurers required to share with state Medicaid agencies?

States enact laws to comply with section 1902(a) (25) (I)(i) of the Social Security Act. This means that upon request of the state, health insurers must provide information to determine during which period Medicaid beneficiaries may be (or may have been) covered by the health insurer. The insurer is also required to detail the nature of that coverage.

This information includes, at a minimum, four data elements: the insured’s name, address, group or member ID number and periods of coverage. State laws determine exactly what information is required from the health plans. Health plans are to provide these files to state Medicaid programs so that these programs can determine whether any third-party payers are liable for the medical items and services that were, or will be, delivered to a Medicaid beneficiary. In essence, the point of the information gathering is to ensure that Medicaid benefits are paid correctly.

In the case of health insurers who contract with a pharmacy benefit manager (PBM) or other third-party administrator (TPA) to administer the plan, states also must require that such insurers provide the PBM or TPA with such information as may be necessary to enable that entity to furnish the state with the prescribed data, or deal with such inquiries directly without the aid of their PBM or TPA.

3. How far back can state Medicaid agencies go in requesting eligibility and coverage information from health insurers?

The Deficit Reduction Act of 2005 (DRA) requires states to have laws in effect that require health insurers to honor claims submitted by the Medicaid agency within three years of the date of service.

More information on about Medicaid and third-party resources is available from the federal Centers for Medicare & Medicaid Services (CMS).

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