OHCA Provider Newsletter • November 2023

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SoonerCare Provider Memo

November 2023

Included in This Edition

SoonerSelect Open Enrollment Dates

Most SoonerCare members will get their health care services covered in a new way next year – through SoonerSelect health and dental plans. The open enrollment periods for those plans are coming soon:

  • Dental Plan Open Enrollment
    December 1, 2023 to January 10, 2024
  • Health Plan Open Enrollment
    February 1 to March 10, 2024

SoonerCare members moving to SoonerSelect will be asked to select one dental plan and one health plan. If they don’t select a plan, OHCA will choose one for them.

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, doctor, or other provider they want to keep, they should pick the plan that has that provider in the plan’s network.

View dental and health key implementation steps. Members with questions can visit the SoonerSelect FAQ page or call the SoonerCare helpline at 800-987-7767 to talk to plan choice counselors.

Provider Information and Renewals

Provider Information
To ensure that all provider files are up to date, OHCA reminds you to log into the secure provider portal and confirm that your address, contact information and other demographic information is correct. This information can be checked and corrected by selecting the “update provider files” link once logged in to the admin account. For more information on how to update the provider file, please view the SoonerCare Provider Contracts presentation on OHCA’s Training Page or email SoonerCareEducation@okhca.org.

Provider Renewals
The provider types below are open or will be opening for renewals soon. Please be sure to log in to your provider file and complete the renewal process prior to the expiration date. Failure to do so may result in denial of payment after the expiration date.

  • Physician Assistants
    Open for renewal on Nov. 17, 2023, and will expire on Jan. 31, 2024.
  • Licensed Behavioral Health Practitioners
    Open for renewal on Dec. 15, 2023, and will expire on Feb. 28, 2024.

Patient Eligibility and Prior Authorizations

SoonerCare eligibility reviews are ongoing. Those members who are no longer eligible are having their coverage ended in phases over the next 2 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.

Durable Medical Equipment Needs

Able Tech logo

Make room for the turkey! If you have gently used durable medical equipment that you are no longer using, please either return it or donate it to Oklahoma ABLE Tech's Device Reutilization Program. This program is 100% donation-based — which means without community contributions, there is not a robust inventory!

Our greatest needs are blood pressure monitors, grab bars, lift chairs and manual wheelchairs.

ABLE Tech staff retrieves donated equipment; sanitizes and refurbishes devices; works with vendors to repair the equipment if needed; and reassigns DME devices to the best-matched Oklahoman. Any Oklahoman who needs medical equipment or devices, regardless of income, is eligible for the program. Priority will be given to SoonerCare members.

Complete the online device donation form to schedule a drop-off or pick-up!

Speech Therapy FAQs  

Photo of a speech therapist with a child

What is Modifier 52?
Modifier 52 identifies a service that has been partially reduced. For example, if completing a comprehensive evaluation for CPT 92523, it indicates parts of the evaluation were completed but the member was unable to complete the entire evaluation.

When should I use Modifier 52?
You should use Modifier 52 when a member is unable to complete the comprehensive evaluation. For example: A two-year-old member that only has two words may be able to complete language testing (or rating scales with parents) but would not be able to complete articulation testing due to limited verbal language. It should be noted the member must fully complete articulation testing in order to complete the comprehensive evaluation. Simply scoring an articulation test as though the child had missed every word due to limited verbal output is not appropriate.

How do I know when to use Modifier 52?
On most physician notes, it will clearly state the communication concern. If it mentions the child is non-verbal or only has a few words, then modifier 52 will probably be necessary. The provider should check the physician notes prior to evaluation PA submissio1n to ensure the submission is correct.

I didn’t use Modifier 52 but was unable to complete a full evaluation. What should I do?
The provider should submit an amendment request to add Modifier 52 to the evaluation BEFORE submitting the evaluation claim for reimbursement. The claim can be submitted once the amendment is approved.

If I use Modifier 52 and a full evaluation is obtained, can I remove the modifier?
Yes! The provider just needs to submit an amendment through the provider portal BEFORE submitting for payment with the full evaluation and OHCA Medical Authorization Prior Authorization Amendment Form HC 60 attached to request the modifier be removed. You may submit for payment after the amendment is approved. 

Lung Cancer Awareness Month

Healthy lung graphic

November is Lung Cancer Awareness Month, a time to learn about the risks of lung cancer and the importance of early detection and prevention. This month drives home one critical reminder to physicians and patients — quitting tobacco is one of the best things you can do for your body.  

As a health care provider, your support can empower patients to take a significant step toward a healthier, smoke-free life. Quitting tobacco is a personal journey. Even if health isn’t a priority for your patients, it may be the driving force to help them succeed.

It’s common for tobacco users to explore various quit strategies, often attempting to quit more than once. The Helpline advises Oklahomans to begin their journey with small steps to ultimately achieve significant milestones while always acknowledging their successes and facing tobacco cravings head on. If your patients are looking for a tobacco quit date, motivation to quit or accountability to stick with it, Lung Cancer Awareness Month is the perfect opportunity.

Limited-Time Offer: 8 Weeks of Free Patches, Gum or Lozenges

Your patients can double their chances of successfully quitting with nicotine replacement therapy. Now through November 30, your patients can receive a free 8-week supply of patches, gum or lozenges from the Oklahoma Tobacco Helpline. Learn more about this limited-time offer by visiting OKhelpline, calling 1-800-QUIT NOW or texting READY to 34191.

The Helpline’s free office materials can help you start the conversation about quitting tobacco. Clipboards, badge reels, pens, prescription pads and more are great ways to bring attention to the Helpline’s free resources. 

Hepatitis C Virus (HCV) Treatment Coverage

MAVYRET® (glecaprevir/pibrentasvir) is currently SoonerCare’s only preferred direct-acting antiviral (DAA) medication for treatment of HCV. It is available without prior authorization (PA) as part of an initiative by OHCA to cure HCV in the SoonerCare population.

For other DAAs, the PA criteria is still in effect and PA forms are still required. Additionally, PA requests for other DAAs require a patient-specific, clinically significant reason why the member cannot use MAVYRET. The specific PA requirements are located on the OHCA website in the “Hepatic Disorders” therapeutic category. Initial PA requests for all other DAAs besides MAVYRET must be submitted using all 3 HCV PA forms:

  1. The medication-specific PA form (e.g., HARVONI®, Pharm-33)
  2. Hepatitis C Therapy Intent to Treat Contract form (i.e., Pharm-28)
  3. Hepatitis C Therapy Pharmacy Agreement form (i.e., Pharm-29)

Continuation requests for each refill must be submitted using the Hepatitis C Therapy Continuation form (i.e., Pharm-30). Find the PA forms are located on the OHCA website.

Please follow current guidelines and MAVYRET prescribing information when initiating testing for HCV, selecting an appropriate treatment regimen, and performing all necessary monitoring. As the COVID-19 public health emergency has ended, the eligibility of some members may be ending soon. Before starting therapy for HCV, prescribers are encouraged to verify that the member's SoonerCare eligibility is in effect long enough to complete treatment.  All patients should be monitored and counseled regarding the importance of compliance and finishing treatment.

Nutrition Therapy Benefit

Photo of carrots

We know that foods packed with fiber, vitamins, minerals, and antioxidants can act as medicine for the body. Vegetables like carrots can increase the amount of fiber that helps lower bad cholesterol. In addition, beta carotene found in carrots provides vitamin A, antioxidants and anti-cancer properties. Learn more about SoonerCare’s medical nutrition therapy benefit for your patients and refer them today!

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