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October 2022
At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE). During the PHE, we are required to continue SoonerCare coverage for all members even though there are some members who no longer qualify for benefits.
Example of reasons why a member may no longer qualify for benefits:
- Your salary is now higher than the required amount to receive SoonerCare benefits.
- Someone has moved in or out of your household.
- Your contact information and/or documents are not updated at mysoonercare.org.
There will come a time when the PHE will end. Once we know the day, we will send notifications to those people who no longer will receive SoonerCare benefits. Those members determined to be ineligible for benefits will be removed from SoonerCare in phases focusing on the member’s benefit utilization and critical health issues.
Members who are ineligible will receive four notices:
- The first letter, printed on purple paper, will announce the end of the PHE. The member’s end date and the reason for the removal will NOT be posted on this letter. All members will see an end date of January 31, 2023, on their electronic portal until the second letter is sent with more detailed information.
- The second letter, printed on white paper, will be sent to all affected members detailing their end date and the reason for removal. Their new end date will be reflected in the electronic portal.
- A third letter, also printed on white paper, will be sent to affected members 45 days prior to their scheduled end date to inform them of the reason for loss of eligibility, potentially missing documents to verify eligibility, and appeal rights.
- A fourth letter will be sent 10 days before the member loses eligibility.
Members should take time to think about their health care needs and plan in case their SoonerCare coverage ends. Please go to MySoonerCare.org to learn more.
SoonerCare has updated the patient dismissal process for our patient-centered medical homes. It includes new dismissal guidelines for inactive members, which are members that have not been seen by the provider in at least 24 months.
The updated process can be found on our patient-centered medical home webpage under the PCP Tools and Resources section. Dismissal requests continue to be electronic and done on the secure provider portal.
Do you have dental questions relating to policy or code frequency? Quick reference guides, prior authorization guidelines, forms, training, and more are available through our public webpage at https://oklahoma.gov/ohca/providers/types/dental/dental.html.
We’ve helped over 470,000 Oklahomans … and we’re not stopping now.
Are your patients looking to make a healthy change? Quitting tobacco is the best place to start — but it can also be the hardest. The good news is that the Oklahoma Tobacco Helpline and SoonerCare are on their side.
What Does the Helpline Have to Offer?
When your patients are ready to quit, the Helpline is here with:
- One-on-one web coaching calls
- Supportive texts
- At least a two-week supply of free patches, gum or lozenges
- An encouraging online community
SoonerCare Benefits
In addition, SoonerCare offers even more free benefits to quit tobacco through the Helpline, including:
- Eight counseling sessions per calendar year
- All FDA-approved, tobacco-cessation products such as nasal sprays, an inhaler, a 180-day supply of Zyban or Chantix and patches, gum or lozenges
These products are available without copays or prior authorization with a prescription from a contracted provider. And the best part? These benefits do not count against SoonerCare’s six-prescription limit!
Spread the Word
Want to start the conversation before you enter the room? The Oklahoma Tobacco Helpline has FREE materials such as pens, brochures, clipboards and badge reels to help your patients kick off their tobacco-free journey. Order your FREE materials today at OKhelpline.com/order.
Don’t wait. Encourage your patients to quit tobacco with the Helpline today.
Have you heard a member story that is too good not to share? We would love to share it with our members and other stakeholders. Send the details to the Strategic Communications team at strategiccommunications@okhca.org. This story could be shared on social media, in emails and other communications!
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