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OHCA Dental Newsletter - August 2020
 
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OHCA caries risk assessment forms have been updated to more closely resemble the ADA caries risk assessment forms. The updated forms can be found here.
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The teledentistry policy implemented due to the COVID-19 pandemic has been extended through Sept. 30, 2020. This policy allows the D0140 code to be reimbursed when utilized through teledentistry and coupled with the D9995 code. Teledentistry is a live, two-way, audio-visual, interactive encounter between the patient and the provider. Providers must meet the OHCA telehealth requirements as outlined in 317:30-3-27. Providers should comply with the ADA policy on teledentistry which can be found here.
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SoonerCare benefits include code D4346 - scaling in the presence of generalized moderate or severe gingival inflammation. This code may be utilized for the removal of plaque and calculus from supra- and sub-gingival tooth surfaces when there is generalized moderate or severe gingival inflammation in the absence of periodontitis. This code requires prior authorization. For more information about this code click here.
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Due to the COVID-19 pandemic, 2020 SoonerCare provider training workshops will be postponed. Training assistance is available by telephone from our SoonerCare education team.
Training is still available for the Insure Oklahoma program, SoonerCare referrals, patient-centered medical homes, provider enrollment and contracting, claims resolution and promoting literacy during the well-child visit through the Reach Out and Read program.
For training requests, contact the SoonerCare education team. Please include the provider’s name, SoonerCare ID number, a return phone number and a contact name with the request.
Email: SoonerCareEducation@okhca.org
Phone: 405-522-7422
Fax: 405-530-3288
Don’t miss our web alerts. *Sign up to be notified about new SoonerCare training opportunities.
Tips to prevent your prior authorization request from being sent back to you for documentation:
- All photos, images and radiographs should include member name, date taken, right and left for BW images, tooth number or periapical images. All images should be of diagnostic quality.
- OHCA caries risk assessment forms have been updated to include newest ADA revisions and can be found here.
- When requesting prior authorization for fixed prosthetics (crowns), provide documentation regarding the member's oral hygiene status. A current caries risk assessment is also acceptable.
- When requesting prior authorization for D4346, include photographic and radiographic images as well as periodontal charting.
- If requesting a third year of orthodontic treatment, members must have had a cleaning within the past year. If a cleaning was provided by a dentist who is not a SoonerCare provider, please document the dentist's name and the date of service.
- Please ensure all forms are filled out completely: HLLD (DEN-6), Referral for orthodontics (DEN-2) and caries risk assessment.
Did you know? OHCA has a page devoted to dental services – it contains links to policy, the dental fee schedule, dental forms and other useful information.
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OHCA offices will be closed on the following dates, as they are observed as holidays by the state of Oklahoma:
- Sept. 7 – Labor Day
- Nov. 26 & 27 – Thanksgiving
- Dec. 24 & 25 – Christmas
We will be happy to assist you during our regular office hours.
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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 prevent interruption of their benefits. You can 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 800-987-7767.
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The oral health of Oklahomans was rated on 13 key oral health indicators and compared to the nation's overall performance. Though the results are not encouraging, they do give us a baseline upon which we can improve. OHCA continues to be committed to cultivating relationships to improve oral health outcomes for Oklahomans. In June, it was decided that OHCA would seek proposals from managed care organizations which we hope will help improve oral health access and outcomes in Oklahoma. View the recent Oklahoma Oral Health Report Card here.
- After an unusual legislative session, Gov. J. Kevin Stitt signed a total of 162 bills and vetoed 18. In a typical session, 400-500 bills would have been sent to the Governor's desk. Due to the health emergency, legislators did not meet between March 17 and May 4. When they did reconvene, it was mainly to address the budget and very few policy bills were heard. The budget agreement resulted in average cuts of 4% to state agencies. OHCA’s budget only saw about a 2% cut.
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SB1937 – allows OHCA flexibility with utilizing the Rate Preservation Fund to maintain provider rates.
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SJR0027 – proposes a vote of the people on a constitutional amendment that modifies the payments to the Tobacco Settlement Endowment Trust Fund. This amendment would specify 75% of the deposits into the fund be appropriated to pay for Medicaid. This proposal will be on the November ballot.
- With the passing of State Question 802, the agency is preparing a state plan amendment to expand Medicaid. New members will be able to enroll beginning in July 2021. The agency is already meeting with state leaders to discuss funding mechanisms.
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Kevin Corbett was confirmed by the Senate to continue serving as the Oklahoma Health Care Authority CEO.
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 Visit OKhelpline.com for free promotional items to display in your office like posters, fact sheets, brochures and more.
Encourage your patients to reach out to the Oklahoma Tobacco Helpline for FREE support and tools to help them quit. They can call 1-800-QUIT NOW or visit OKhelpline.com to find help and start quitting today!
Talk About The Risks
Tobacco causes gum disease, tooth loss and cancer, along with an increased risk of stroke and diabetes.
Evidence-Based Cessation Methods
The Surgeon General’s new report finds that combining counseling with nicotine replacement therapy leads to higher success rates. With a trained helpline quit coach, your patients can receive free support via phone, email or text. They may also qualify to receive at least a two-week supply of nicotine replacement therapy.
The Oklahoma Tobacco Helpline
The helpline is available to all Oklahomans 13 and older. With three free plans, your patients can customize helpline services to fit their needs, including pregnant women. Plus, SoonerCare members qualify for additional medications when prescribed by their doctor.
Additional Benefits For SoonerCare Members
SoonerCare members may receive counseling as well as prescription and over-the-counter medications to quit tobacco. With a doctor’s prescription, SoonerCare members have access to not only patches, gum and lozenges, but nasal spray, inhalers, Zyban and Chantix as well.
FREE Materials For Your Office
The helpline also has resources for health care providers. Visit OKhelpline.com to order free promotional materials for your office. Brochures, pens, posters, cards with quitting tips, vaping materials and more are available.
For more information related to electronic nicotine delivery systems visit StopsWithMe.com.
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General Questions:
Q: How will I know about changes to SoonerCare policies and rules?
A: OHCA provides policy and program information in several ways:
- Web alerts – Sign up in the provider portal
- Global messages
- Provider letters
- Dental newsletter and provider newsletter
Q: How can I view or make comments regarding upcoming changes?
A: Click here. The public can also make comments at OHCA board meetings or Medical Advisory Committee meetings.
Q: How do I contest a denied claim?
A: Please fill out an HCA-17 and mail it to the address on the form. Be sure to include any radiographs, clinical notes and other documentation to support medically necessary payment. The HCA-17 form may be found here.
Orthodontics Questions:
Q: How do I submit a prior authorization for comprehensive orthodontic treatment (D8080)?
A: Create two service detail lines when initiating a prior authorization in the portal. These will represent your first year (line A) and second year (line B), if approved. Third year submissions only need to be submitted with one service detail line.
Q: What dates do I enter in the requested from and to date fields when creating a prior authorization in the provider portal?
A: When entering a prior authorization, both your requested from and to fields will be the current calendar date on which you are completing the prior authorization request, and will not be different from each other. For example, if you were entering an authorization in today, you would enter today’s date in both the from and the to fields. Entering in a date span may result in your prior authorization being cancelled.
The oral health of Oklahomans was rated on 13 key oral health indicators and compared to the nation's overall performance. Though the results are not encouraging, they do give us a baseline upon which we can improve upon. OHCA continues to be committed to cultivating relationships to improve oral health outcomes for Oklahomans. Thank you to all our providers for being part of the solution.
You can view the recent Oklahoma Oral Health Report Card here.
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OHCA Provider Helpline: 800-522-0114
Dental Prior Authorization Unit: 405-522-7401
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