October 2023
SoonerCare eligibility reviews are ongoing. Those members who are no longer eligible are having their coverage ended in phases over the next 4 months.
Please continue to check eligibility and ensure there is a current prior authorization on file for the member before delivering treatment-planned services. Eligibility must be verified on the service date before services are rendered. When checking eligibility on the provider portal, a single service date must be used; date span searches will not provide accurate information. Questions? Contact the Provider Helpline at 800-522-0114 or SoonerCareEducation@okhca.org.
Most SoonerCare members will get their health care services covered in a new way next year – through medical and dental plans.
SoonerSelect open enrollment periods are coming soon. SoonerCare members moving to SoonerSelect will be asked to select one dental plan and one medical plan. If they don’t select a plan, OHCA will choose one for them.
The enrollment periods are:
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Dental Plan Open Enrollment
December 1, 2023 to January 10, 2024
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Medical Plan Open Enrollment
February 1 to March 10, 2024
Please remind your patients that it’s important they review the plans. They should compare benefits and choose the plan that’s right for them. If they have a dentist or doctor they want to keep, they should pick the plan that has that provider in the plan’s network.
View dental and medical key implementation steps. Members with questions can visit the SoonerSelect FAQ page or call the SoonerCare helpline at 800-987-7767.
The Provider Training page on OHCA's website offers a list of upcoming webinars, as well as replays of past webinars, how-to videos and other resources. Upcoming events include:
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Low-Dose Aspirin in Pregnancy Initiative Training
Tuesday, Oct. 31, 2023 • 10-11:30 a.m.
Register to attend
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COVID Resource Exchange (CRX): ECHO Series
Monday, Nov. 13, Monday, Dec. 11 & Monday, Jan. 9
Learn more and register
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Long-Acting Reversible Contraceptive Training
Saturday, Dec. 9, 2023 • Tahlequah
Saturday, March 9, 2024 • Oklahoma City
Saturday, April 13, 2024 • Tulsa
Learn more
Each year, medications for attention-deficit/hyperactivity disorder (ADHD) are among the most prescribed for members covered by SoonerCare. Nearly 25 years of reporting from the Centers for Disease Control and Prevention confirms ADHD as one the most common mental health disorders for children ages 3-17. While estimates vary across geographic and demographic designations, nearly 10% of all children have been diagnosed with ADHD, and in Oklahoma more than 88% of all children with ADHD have received at least some ADHD treatment within the last 12 months.
According to the latest guidelines from the American Academy of Pediatrics, the following are grade A, strong recommendations:
If you are concerned that your treatment of ADHD is currently not in keeping with best practice recommendations, please consider using the following resources:
- Peer-to-peer consultation with an OHCA child psychiatrist. Call 405-522-7597 to schedule a consultation.
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Project ECHO (Extension for Community Health Care Outcomes) for pediatric behavioral and emotional health.
- Oklahoma Child and Adolescent Psychiatry and Mental Health Access Program (OKCAPMAP).
For SoonerCare medication coverage-related questions, including ADHD medications, contact the Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.
When talking with your patients about their overall health, make it a priority to mention the connection between tobacco usage and type 2 diabetes. Smoking increases the risk of type 2 diabetes by up to 40%. It leads to more health problems including higher cortisol levels, decreased blood flow, plaque buildup in the arteries, heart disease, kidney disease, poor blood circulation, and nerve damage in the arms and legs.
Using nicotine also makes insulin treatments less effective. Smokers with type 2 diabetes often need to increase their insulin dosage, making it more expensive. Explaining the future health risks of type 2 diabetes to your patients could be the extra push they need to quit.
For patients who smoke and already have type 2 diabetes, explain that their quality of life will only increase when they quit smoking. Living with diabetes is more manageable without the added stress of side effects from smoking.
The Oklahoma Tobacco Helpline provides free services to help your patients quit. Encourage them to sign up for patches, gum or lozenges, coaching, live group sessions and more. And be sure to get free materials for your office, including pens, brochures and prescription pads.
OHCA has a page devoted to services for dental providers. It contains policy links, the dental fee schedule, forms, codes, special waivers, FAQs and other useful information. In addition, by logging into the provider portal, you can view items such as prior authorization status.
As health care providers, you know that people living with diabetes come across challenges and could use support from a diabetes educator along the way. SoonerCare offers a diabetes self-management education and support (DSMES) benefit that can be exactly what your patients need. Visit our diabetes page to learn more and refer your patients who struggle today!
In observance of Health Literacy Month this October, we want to address an important health concern that affects many of our patients: the use of e-cigarettes or vaping.
It’s crucial to inform patients about the dangers associated with vaping. The e-liquid used in e-cigarettes contains unknown levels of nicotine, which keeps patients addicted to a habit that exposes them to chemicals that can cause significant harm to the lungs and are associated with an increased risk for cough, wheezing, and asthma exacerbations.
SoonerCare is committed to supporting our providers in helping patients quit smoking and vaping. Please don't stop at encouraging your patients to call 1-800-QUIT-NOW; make a referral on their behalf. Counsel your patients about personalized, proven methods and FDA-approved treatments for tobacco cessation, which can significantly improve their chances of quitting successfully. And don’t forget to inform them that NRT does not count against their six-prescription limit, either!
WHAT IS REQUIRED TO COMPLETE A THERAPY PA SUBMISSION?
For each PA submission, please include:
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HCA 61 PA request form.
- Valid script for specified therapy services. The script MUST say PT, OT or ST. A script is valid for one year from the date of the physician's signature.
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HCA SC 15 parental consent form or clinic-specific parental consent form with ALL elements of HCA SC 15 form. The form must include all requested treatment dates.
- Detailed documentation including:
- History of therapy services
- Current services
- Standardized testing with results
- Member/caregiver desired outcomes
- Functional and measurable goals
- Proposed plan of care to include medically justified requested number of units and dates of service
WHAT IS REQUIRED TO INCLUDE WHEN REQUESTING ADDITIONAL UNITS OR CONTINUATION OF SERVICES?
All the items listed above AND all of the following:
- Detailed progress of goals, including percentage of previous goals completed and reason unmet goals were not met.
- Progress note.
- Discharge plan.
- Medical justification for number of units/visits being requested.
WHAT IS REQUIRED TO CHANGE THE PREVIOUSLY APPROVED THERAPY TO A DIFFERENT PROVIDER?
Submit all PA submission requirements as listed above AND all the following:
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HCA SC 16 change of provider form.
- A letter from the new provider that is signed/dated and states they accept the previous provider’s plan of care and goals OR a new evaluation must be submitted. Evaluations are valid for one year.
WHEN DOES A DOCUMENT NEED A CO-SIGNER?
For SLP Clinical Fellows and SLPAs, OHCA requires all clinical documentation to be co-signed by a fully certified, contracted SLP. PTA and COTA progress notes must be co-signed by their supervising PT or OT.
Reminder: To ensure faster processing times, submit one PA for each member. If you have questions about a PA, check the status in the provider portal.
PLEASE FILL OUT ALL FORMS IN THEIR ENTIRETY.
For more information, please refer to therapy OT-/PT- and ST-specific guidance sheets and the provider handbook.
OHCA partners with Oklahoma ABLE Tech to provide gently used durable medical equipment (DME) to SoonerCare members and other Oklahomans. ABLE Tech is a great place to donate unused DME and a great resource to seek if you need DME. And because ABLE Tech is also the state's assistive technology program, they provide many more helpful programs and services, too. Learn all ABLE Tech offers and how technology is helping people live independently.
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