OHCA Provider Newsletter • February 2024

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SoonerCare Provider Memo

February 2024

Included in This Edition

Free SoonerSelect Flyers for Your Office

Pick a Plan flyers

Most SoonerCare members will get their health care services covered in a new way next year – through SoonerSelect dental and health. The dental open enrollment period closed on Jan. 10, 2024. Enrollment for the health plans is open and runs through March 10, 2024. 

SoonerCare members transitioning to SoonerSelect are asked to review the health plans and select the one that is right for them. They should compare benefits, and, if they have a primary care physician they want to keep, they should pick the plan with that provider in the plan’s network. If they don’t select a plan, OHCA will choose one for them.

You can help remind your patients of the importance of reviewing these plans by downloading any of our free flyers today. Visit OHCA's publications page and scroll down to the flyer section. Flyers come in different designs and are available in both English and Spanish. All flyers include the open enrollment dates. Just download the ones of your choice and hang them in your office.

Provider Survey

Postcards with the survey link to the annual Provider Survey have been mailed. The Oklahoma Health Care Authority is asking its partner providers to help the agency improve. The agency distributed its annual Provider Survey to all SoonerCare rendering providers (those with more than 25 claims in 6 months). OHCA uses the feedback from providers to improve SoonerCare for members and enhance the provider experience with OHCA. Complete the survey by March 22.

Let the Helpline Help Your Patients Quit Tobacco

Quitting tobacco is not easy. The Oklahoma Tobacco Helpline is dedicated to equipping every Oklahoman with the necessary tools to help them successfully quit. One tool the Helpline provides is nicotine replacement therapy (NRT) in the form of patches, gum or lozenges. NRT doubles the chances of a successful quit!

Through Feb. 29, patients can receive 8 weeks of nicotine patches, gum or lozenges free. Learn more about this limited-time offer at OKhelpline.com/8weeks, by calling 1-800-QUIT NOW or texting READY to 34191.

One Conversation Can Change Everything

Last year, 4 out of every 9 adult smokers who saw a health care professional did NOT receive advice to quit. Your patients trust your expertise. Encourage them to make a life-changing — and life-saving — change by contacting the Helpline.

In addition to NRT, here are a few of the free quit services available to your patient.

  • Coach support: Engaging sessions via phone, text and chat. Coaches provide quit strategies, tips and support navigating the Helpline.
  • Live online group sessions: Coach-led meetings facilitating peer connections, coaching and advice.
  • Encouraging texts and emails: One-on-one and automated options offer timely tips when your patients need them most.

The Helpline has helped thousands of Oklahomans live a tobacco-free life. Your patients could be next. If you need help starting the conversation, order free materials for your office to educate patients on the Helpline’s benefits and encourage them toward a tobacco-free life. 

Championing Lung Health

Image of lung X-ray

You’re at the forefront of our efforts to champion lung health. You have the power to change outcomes, and we’re here to support you.

According to the American Lung Association, lung cancer remains a leading threat, yet less than 2% of at-risk patients receive screenings. The U.S. Preventative Services Task Force advises that early detection via low-dose CT (LDCT) screening can significantly reduce lung cancer mortality by 20%.

SoonerCare has adopted updated USPSTF guidelines, expanding eligibility for LDCT lung cancer screenings. Now, more of your patients can benefit from this potentially life-saving scan.

Eligibility for LDCT Lung Cancer Screening:

  • Patients age 50-80
  • Current smokers
  • Former smokers who have been smoke-free for 15 years or less
  • Those with a 20-pack-year history or more, with no current symptoms or history of lung cancer

For first-time referrals, ensure a shared decision-making visit is documented that covers:

  • Eligibility determination
  • Benefits and risks of screening
  • Possible impacts and outcomes
  • The need for further procedures, if necessary
  • Adherence to screening, treatment comorbidities, and smoking abstinence

SoonerCare covers the screening and counseling visit at no cost to the patient, reaffirming our commitment to proactive health care. Review the detailed coding and reimbursement information.

For any inquiries or guidance on optimizing this benefit for your patients, reach out to SoonerQuit@okhca.org. Together, we can turn the tide against lung cancer and offer our patients the gift of early detection and improved health outcomes.

Help Patients Find a Nutrition Balance

Photo of hearty meal

Winter weather often causes people to overeat, resulting in weight gain. Finding a balance is key, especially for those who have diabetes. As health care providers, you're aware that this struggle, for those living with diabetes, can result in severe complications. SoonerCare offers a diabetes self-management education and support (DSMES) benefit that can be exactly what your patients need. 

Maintenance Brand Preferred Forms

Photo of pill vial

Several forms have been added to the pharmacy page. Recent additions include the Prior Authorization (PA) Amendment Form, created to facilitate small changes to an existing PA (e.g., change of pharmacy, strength or drug regimen). Each month, new forms are added, and existing forms are updated, so making sure you are using only the current forms can help you remove several steps in the PA process.

Checking the brand required drug list is another way you can save steps in the PA process. In some instances, using the brand name product is more cost-effective for SoonerCare, and the brand is preferred over its generic equivalent. A patient-specific clinically significant reason to use the generic must be provided for these drugs. Some commonly used drugs that are brand required include:

  • Aptensio XR
  • Butrans
  • Daytrana
  • Focalin XR
  • Nuvigil
  • Oxycontin
  • Proventil HFA
  • Symbicort
  • Vyvanse

Providers can also improve the PA process for members by prescribing drugs on the maintenance drug list. These drugs are covered for a 90-day supply without a quantity or day supply override. Pharmacists are now permitted to authorize a 90-day supply of non-controlled maintenance drugs.

With some easy planning and prescribing from this list, many members could receive 12 or more maintenance drugs and also have prescription coverage for an additional 2 drugs each month for acute conditions. The list currently includes maintenance drugs from 16 drug categories:

  • Alzheimer’s disease
  • Anticonvulsants
  • Antidepressants/anxiolytics
  • Antihypertensives
  • Antipsychotics
  • Anti-ulcer
  • Bladder control
  • Benign prostate hyperplasia (BPH)
  • Cardiovascular
  • Chronic obstructive pulmonary disease (COPD)
  • Diabetes
  • Glaucoma
  • Hyperlipidemia
  • Non-controlled attention-deficit/hyperactivity disorder (ADHD)
  • Parkinson’s disease
  • Thyroid replacement

Please note that not all drugs in each category can be processed for a 90-day supply. Clinical criteria and tier structure rules still apply to certain maintenance drugs.

For SoonerCare drug coverage-related questions, including maintenance drugs, please contact the Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.

Therapy FAQs

Photo of a man in physical therapy


What do I need to submit with my change of provider form?

A change of provider form is necessary when a member changes rendered service locations from one entity to another. This will require a new prior authorization (PA) request with appropriate documentation.

If the new location staff performs their own initial evaluation, the new evaluation must be submitted along with all other required documents (i.e., parental consent, HCA 61, referring provider script). If the new location is continuing services as established by the previous plan of care submitted by the previous location, then the previously completed initial evaluation may be submitted. In this case, a statement of approval of the previously established care plan by the new therapist of record is necessary.

Additionally, the new provider must submit a note demonstrating progress towards the established therapy goal(s), including commentary supported by current subjective and objective measurements. Progress notes should be completed every 30 days or less. Benefits of using a timeline that is 30 days or less include:

  • Effective tracking of goals achieved.
  • Health outcome results from rendered services.
  • Establishing support for demonstrating medical necessity.
  • Creating a cohesive history for submission of future PA requests.
  • Changing providers for covered services.

If the previous location has completed a progress note within the past 30 days of the new location’s anticipated treatment start date, then the previous progress note may be submitted with other documents as described above. When preparing your PA submission, it is important to note that OHCA covers only one PT evaluation per member per year.



How often can I be paid for a comprehensive 92523 evaluation?

Each member is allowed one comprehensive 92523 evaluation per calendar year. If there are extenuating circumstances, a provider may request a second evaluation, but a full justification for medical necessity must be included with the request. Prior authorization requests for re-evaluations should be requested no more than 10 months from the date of the most recent evaluation.

If a member changes providers, can they receive a new comprehensive 92523 evaluation?

If a member changes providers, they may receive a new comprehensive 92523 evaluation six months after the most recent evaluation. If a member had an evaluation less than six months ago, the new provider should contact the previous provider to obtain the most recent evaluation.  



Is there someone I can contact for general SoonerCare questions about therapies?

If your question includes a concern involving a prior authorization number and its decision, please email therapyadmin@okhca.org. If you have questions about claims/reimbursement, policy, provider portal usage, enrollment/eligibility, or general inquiries about SoonerCare, please call 800-522-0114.

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