OHCA Provider Newsletter

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SoonerCare Provider Memo

February 2022

Included in This Edition

Provider Town Hall - April 14

Join OHCA at the Renaissance Hotel in Tulsa or virtually on Thursday, April 14 from 9 a.m. to 4 p.m. to discuss our Comprehensive Quality Strategy about the care provided to SoonerCare members. More information and registration will be provided soon.

Free At-Home COVID-19 Testing Kits for SoonerCare Members

SoonerCare members can now get over-the-counter COVID-19 testing kits at no cost through any SoonerCare-contracted pharmacy. These at-home tests can provide results in 30 minutes or less and do not count against the monthly prescription limit.

Patient-Centered Medical Home (PCMH) Redesign Webinar

This webinar will provide an overview of the SoonerCare Choice compliance review and tier requirement change effective Jan. 1, 2023. Attendees will learn more about the opportunity to participate in mock audits, provider engagement process changes and SoonerCare Choice website updates.

March 8 from 2 - 3:30 p.m. - Click here to register
March 24 from 2 - 3:30 p.m. - Click here to register

Please send comments and questions to medhomecomments@okhca.org.

After registering, you will receive a confirmation email containing information about joining the webinar and reminder emails before the webinar begins. Registrants unable to attend the webinar session should notify Soonercareeducation@okhca.org to cancel their registration.

Resubmitting Denied Claims for Consideration of Payment

Claims for expansion adults enrolled in the SoonerCare Choice program that were denied for no PCP referral for dates of service prior to Jan. 1, 2022, may be resubmitted for consideration of payment. A referral guide is available on the OHCA provider training page

Care Management Provider Survey

OHCA is encouraging providers to complete a brief questionnaire so we may assess and increase provider awareness of care coordination services available to members with higher levels of social and health care needs.

Please follow this link to participate in the Care Management Provider Survey.

Quality Improvement at OHCA

The Quality Improvement (QI) unit at OHCA is developing a comprehensive quality strategy (CQS) focused on improving health outcomes. We are gathering information from healthcare providers across Oklahoma, other state agencies and SoonerCare members. We are prioritizing the social determinants of health, health equity, obesity, tobacco use and teen pregnancy because they can greatly increase the risk of poor health outcomes.

OHCA has met virtually with some providers to gather feedback for the CQS, and there is an in-person provider session planned for April 14 in Tulsa. Watch for an invitation to attend arriving by email soon. 

Please Do Not Submit Duplicate Prior Authorization Requests

Due to SoonerCare's added adult dental benefits and welcoming more than 200,000 new members through Medicaid expansion, we have seen a significant increase in the amount of authorization requests we receive per day. We appreciate your patience as we work diligently to quicken our turnaround times.

Providers can assist us with ensuring they stay up-to-date on their prior authorizations and do not submit duplicate requests, as this will cause insufficient processing. Please visit our provider training page for materials on how to view authorization notifications and statuses.

Diabetes Self-Management Education and Support for SoonerCare Members

Did you know SoonerCare providers can refer members with a diabetes diagnosis to a covered DSMES program? 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.

Contract Expiration Dates

The following contracts all expire March 31, 2022:

Ambulance Service
Occupational Therapist
Physical Therapist
Speech Pathologist

Free Support to Quit Tobacco



The Oklahoma Tobacco Helpline offers three free quit plans designed for work for any lifestyle:

All Access - This plan includes free NRT, quit coach calls, web coaching, a quit guide, and supportive texts and emails.

Web Coach - This plan includes everything within All Access minus the quit coach calls.

Individual Services - This plan enables patients to mix and match the services they want including NRT, supportive texts and emails, a quit guide, and more.


Additional Quit Benefits for SoonerCare Members

  • Eight counseling sessions per rolling calendar year
  • All FDA-approved, tobacco-cessation products
    • While these products require a prescription from a contracted provider, they have zero copays or prior authorizations and do not count against monthly prescription limits.

Contact SoonerQuit@okhca.org with any questions, and find helpful quit materials here.


View complete OHCA calendar here


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