OHCA Provider Memo

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SoonerCare Provider Memo

December 2021

Included in This Edition

OHCA Provider Announcements

New Web Alert System

The Oklahoma Health Care Authority has moved to a new web alert system. OHCA's web alerts will send subscribers an email or text message when updates are made to certain pages on our website. We currently have three webpages you can subscribe to to receive updates:

  • Proposed policy changes
  • Global messages
  • Public notices

Please click here to subscribe and receive email or text message alerts for the updates most relevant to you. If you were subscribed to web alerts on our previous web alert system, you will need to subscribe through our new system to continue receiving alerts.

Monthly Training Webinars

OHCA administers monthly training webinars on a wide range of topics. To view upcoming trainings or to find materials and resources please visit our training page: https://oklahoma.gov/ohca/providers/provider-training.html

Patient-Centered Medical Home Program with Updated Incentive Payment Structure

Beginning in January, OHCA will roll out an enhanced Patient-Centered Medical Home program with an updated SoonerExcel incentive payment structure. We will use outcome linked measures and adjusted incentive payments to reward improvements and achievements with our PCMH providers. For more information visit our SoonerExcel webpage: https://oklahoma.gov/ohca/providers/types/soonercare-choice/incentive-payments.html

Does My Code Require a Quadrant or a Tooth Number?

Your CDT companion booklet produced by the American Dental Association is a great reference when it comes to procedure code descriptions. Most descriptions contain information about whether the code is specific to a tooth, quadrant and/or arch. Information for arch versus quadrant are as follows:

  • Maxillary Arch 01
  • Mandibular Arch 02
  • Quadrant:
    • Upper Right 10
    • Upper left 20
    • Lower Left 30
    • Lower right 40

'Tis the Season... for Heartburn

While some people experience only temporary heartburn symptoms, others have symptoms consistent with gastroesophageal reflux disease (GERD). For these members, SoonerCare has several options available without prior authorization. Your care team can help members make the most of their benefits by assisting them in identifying anti-ulcer medications available as part of the SoonerCare 90-day Maintenance Drug List.

Of course, many members may not need medication beyond an initial eight week treatment. Guidance for determining appropriate treatment length can be found in recommendations from the American College of Gastroenterology and the American Gastroenterological Association. Specific recommendations for use of proton pump inhibitors (PPIs) include:

  1. Specific PPI formulations should not be selected based on potential risks.
  2. Patients with uncomplicated GERD who respond to short-term PPIs should subsequently attempt to discontinue therapy or reduce the dose.
  3. Patients with GERD and acid-related complications should take a PPI for short-term healing, maintenance of healing, and long-term symptom control.
  4. Patients at high risk for ulcer-related bleeding from non-steroidal anti-inflammatory drugs (NSAIDs) should take a PPI if they continue to take NSAIDs.
  5. Patients with Barrett's esophagus and symptomatic GERD should take a PPI for long-term symptom control.
  6. The dose of long-term PPIs should be periodically reevaluated so the lowest effective dose can be prescribed to manage the condition.

For those SoonerCare members who may benefit from discontinuing use of long-term PPIs, special care should be taken to avoid rebound hyperacidity. The U.S. Department of Veterans Affairs has published tips to increase success when discontinuing use of PPIs.

If you have questions about SoonerCare anti-ulcer medication coverage, call the pharmacy help desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.

Free Support to Quit Tobacco

Tobacco Helpline

The thought of quitting tobacco can be intimidating to your patients — but you can help! Start the conversation with the 5 A’s for the treatment of tobacco dependence. This five part intervention is a proven way for physicians to address tobacco use with patients.  

  • Ask about tobacco use
  • Advise quitting
  • Assess interest in quitting
  • Assist with quitting
  • Arrange follow-up

Next, you can empower your patients with free support from the Oklahoma Tobacco Helpline. When patients combine cessation services and products, it increases their likelihood of successfully quitting. The helpline offers 24/7 support, quit coaching calls, nicotine replacement therapy and more.

Your patients can choose from three plans designed to work for any lifestyle:

  • The All Access Plan includes free nicotine replacement therapy (NRT), quit coach calls, web coaching and a quit guide, plus supportive texts and emails.
  • The Web Coach Plan includes everything in the All Access plan, without the quit coach calls.
  • Individual Services put your patients in the driver’s seat. They pick the services they want — including NRT, plus supportive texts and emails.

SoonerCare members can also access these FDA-approved medications for free: patches, gum, lozenges, nasal spray, inhaler, Bupropion SR (Zyban/Wellbutrin) and Varenicline (Chantix). These products do not count against SoonerCare's six-prescription limit.

Here’s what Candace Hammontree, a former smoker, had to say about her experience with the helpline.

“The quit coaches are absolutely sympathetic and not judgmental. They understand you're in a moment of struggle, and they help you through it. That's exactly what they're there for.”

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