OHCA Provider Checkup

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SoonerCare Provider Memo

July 2021

Provider Notes

SoonerCare Expansion

Since July 1, SoonerCare has welcomed more than 140,000 new members as part of Medicaid expansion. But there are thousands more Oklahomans who now qualify for SoonerCare and may not know it. Talk to your patients about SoonerCare expansion and let them know they may qualify for coverage now, even if they were denied in the past. 

To apply online, find income guidelines and other helpful information, your patients can visit www.mysoonercare.org.

Click here to watch one of our new members discussing how SoonerCare expansion has changed her life.

Thank you for helping us spread the word to more Oklahomans about SoonerCare expansion.

SoonerCare Publications

If your office needs brochures, posters or flyers to help patients learn more about SoonerCare, you can order them here.

Medication Therapy Management Update

OHCA is pleased to offer diabetes self-management education and support (DSMES) as a covered benefit for SoonerCare members. The addition of this service is expected to improve the lives of more than 40,000 SoonerCare members currently living with diabetes, and save the state nearly $135 per month for each member who completes a DSMES program. Widespread evaluation studies have shown that DSMES and similar programs result in:

  • 40% fewer emergency department visits
  • 43% decrease in incidence of end stage renal disease
  • 25% reduction in amputation rates

SoonerCare members with a diabetes diagnosis may now be referred to a covered DSMES program by any SoonerCare provider. SoonerCare members may receive 10 hours of training during the first year, beginning with one hour of individual instruction followed by nine hours of group instruction. Each subsequent calendar year, members are eligible for two hours of individual or group instruction. Due to the ongoing risks associated with COVID-19, group instruction is replaced by individual instruction.

The addition of DSMES coverage follows recently expanded coverage for maintenance diabetes medications and inclusion of continuous glucose monitors for qualifying members at the pharmacy point of sale with a prior authorization. SoonerCare also provides additional resources for providers and members to integrate best practices into the care and management of diabetes. Providers are encouraged to consult resources from the Centers for Disease Control and Prevention (CDC) for additional DSMES information and resources.

Providers seeking to provide DSMES services must meet qualifications and must complete the DSMES-specific enrollment process, including:

  • Enroll the specific DSMES program as a Diabetes Self Management Group, then
  • Enroll specific providers as a Diabetic Educator connecting them to the DSMES program

DSMES providers must complete the DSMES-specific process even if they are already an enrolled SoonerCare provider. For additional provider enrollment questions please call toll free 800-522-0114, then choose option 5.

Global Messages

Are you keeping up with the most recent global messages? We have posted global messages about MCO prior authorization, SoonerCare trainings, important upcoming dates and more. 

Please visit https://oklahoma.gov/ohca/providers/updates/global-messages/global-messages.html to stay current with our most recent information. 

Tobacco CessationJuly TSET

SoonerCare Members Get Even More Benefits

Quitting tobacco is one of the healthiest choices your patients can make, but it can feel intimidating at first. Remind them they don’t have to do it alone; especially with SoonerCare and the Oklahoma Tobacco Helpline by their side.

Start with SoonerCare                                                                                     
SoonerCare members are eligible for many benefits on their path to a tobacco-free life. We covers all FDA-approved medications including gum, patches, lozenges, inhalers, nasal spray, Bupropion SR (Zyban/Wellbutrin) and Varenicline (Chantix). Plus, these medications don’t fall under the standard six-prescription limit each month. Learn more here.

Supplement with the Helpline                                                                                   
Medication alone doesn’t work for many, and combining services and products increases the likelihood of a successful quit. The helpline offers free services like 24/7 online support, quit coaching calls and nicotine replacement therapy. Since 2003, the helpline has helped more than 450,000 Oklahomans. Your patients could be next! 

Spread the Word                                                                                                        
Want to start the conversation before you even walk into the room? Encourage your patients to begin their tobacco-free journey with free helpline promotional materials in your office like pens, posters, brochures, tip cards and more. Order yours today at OKhelpline.com/order.

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