OHCA Provider Newsletter • May 2024

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SoonerCare Provider Memo

May 2024

Included in This Edition

SoonerSelect Provider Resources

Representatives from the SoonerSelect health plans and Children's Specialty Program will be at Oklahoma Health Care Authority from 10 a.m.-3 p.m., Friday, May 10. They will be ready to answer your SoonerSelect questions, so stop by to talk directly with a plan representative.

Additionally, representatives from the SoonerSelect health plans are holding virtual office hours to answer your questions:

  • Aetna Better Health
    Weekdays • 11-11:45 a.m., 2-2:45 p.m. and 5:30-6:15 p.m.
  • Humana Healthy Horizons
    Wednesday, May 15 • 3-5 p.m.
    Wednesday, June 5 • 10 a.m.-noon 
    Wednesday, June 19 • 3-5 p.m.
  • Oklahoma Complete Health
    Tuesdays & Thursdays • 10-11 a.m. 

To join any of these sessions, visit our provider resources page and look for the virtual office hours dropdown. If you have questions, you can email SoonerSelect@okhca.org.

Also, be sure to bookmark the SoonerSelect provider page, as new resources are continually added. Guides, fact sheets, training materials and FAQs are available for both health and dental plans. The provider training page includes a list of upcoming SoonerSelect webinars for which you can register.

5 Stress Management Tips for Your Patients

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As a health care provider, you know how hard stress can be on your mind and body. Stress also makes quitting tobacco and nicotine products much harder. If you have patients who are thinking about quitting, the Oklahoma Tobacco Helpline has a few tips to help them manage stress and fight tobacco cravings.

  1. Take a break and unwind to relax your mind. Visualize a safe and relaxing place and imagine yourself enjoying the peace and quiet for a few moments.
  2. Take a few deep, relaxing breaths — in through your nose and out through your mouth.
  3. Release some endorphins with physical activity. Even a short walk will help lower your stress levels.
  4. Lean on your friends and family. A quick chat over the phone or in person can help ease a worried brain.
  5. Healthy living is self-care. Eat healthy, drink lots of water, sleep well and reduce your caffeine intake to keep the stress at bay.

If your patients are thinking about quitting tobacco, encourage them to contact the Oklahoma Tobacco Helpline. From coach support to nicotine replacement therapy, the Helpline has free quit resources that work. Help start the conversation before you walk into the room with free Helpline materials for your office. 

Clearing the Air: Your Guide to a Tobacco-Free Practice

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Spring is in full bloom, and it’s the perfect time to refresh your commitment to health by creating practices that are tobacco, smoke and vape-free environments. Creating these environments not only alters social norms; it actively fosters a lifestyle that’s free from tobacco’s grasp.

SoonerQuit is proud to offer free Breathe Easy signage and recognition for clinics embracing the gold standard in tobacco-free policies. Remember, there’s no safe level of secondhand smoke exposure, which causes cancer, heart disease, and stroke. Employing a tobacco-free environment is crucial in safeguarding the health of your patients, staff and visitors.

By supporting a tobacco-free environment, we encourage those trying to quit and deter non-users from starting. Tobacco-free environments have been found to protect patients, employees and visitors from secondhand smoke, encourage smokers to quit, and assist with reducing initiation of usage.

SoonerQuit provides a self-guided web-based development guide for an easy and adaptable way to draft your tobacco-free policy, ensuring it aligns with your clinic’s culture. Let’s join forces to bolster tobacco-free social norms and support our members on their path to quitting. Lead the way to cleaner air and healthier lives.

For a guide to implementing your practice’s tobacco-free policy, visit the SoonerQuit webinar on the subject, and together, we can make a lasting impact.

Your Treatment Plan for Diabetes

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Do you consider SoonerCare's Diabetes Self-Management Education and Support (DSMES) referral a critical part of the treatment plan for your patients with diabetes? Expecting people living with diabetes to make lifestyle changes without access to support is unrealistic. Targeted support can help your patients stay motivated and keep them from reverting to unhealthy habits. SoonerCare offers a DSMES benefit that can be exactly what your patients need — find out more and refer them today!

Oklahoma ABLE Tech: Meet Lana

After a referral from Amada Senior Care, Lana reached out to Oklahoma ABLE Tech after she broke her leg, which limited her mobility. The device reutilization program matched her with durable medical equipment (DME) to fit her needs.  

Lana received a portable toilet, which she could transition to easily instead of traveling down the long hallway in her wheelchair. “The loan of this item saved us money and made life a little more bearable while recovering,” said a grateful Lana. “It is much appreciated.”  

Still recovering, Lana looks forward to learning how to walk safely with a walker. 

The Device Reutilization Program provides free DME to the best-matched Oklahomans in need of medical equipment/devices. This program is 100% donation-based — which means it relies on community contribution to have an inventory. Learn how to donate your gently used DME or apply to receive a device on the Oklahoma ABLE Tech device reutilization program page

Is Your Patient’s Asthma Treatment SMART?

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SMART, or Single Maintenance and Reliever Therapy, is the preferred treatment for many patients with asthma, and SoonerCare makes it easy to prescribe SMART! Both SMART agents budesonide/formoterol (Symbicort®-brand preferred) and mometasone furoate/formoterol (Dulera®) are available as Tier-1 medications, and they are part of SoonerCare’s 90-day supply maintenance drug List (see Chronic Obstructive Pulmonary Disease (COPD) Medications list). SMART medications may require prior authorization for some members. Current quantity limits support using these agents as both maintenance and reliever therapy.

For more information, visit the health plan websites and utilize the resources within the provider portals. If you have questions about asthma medication coverage, call the pharmacy help desk associated with your patient’s health plan.

Maternal and Child Health Survey

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The Oklahoma State Department of Health and Oklahoma Human Services are conducting a Maternal and Child Health Needs Assessment. Just a few minutes of your time will help shape programs and guide funding of resources for pregnant women, mothers and children in Oklahoma. Please take a few minutes to fill out the survey. Your participation is appreciated!

Therapy FAQs and SoonerSelect Transition Information

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Following on the heels of April and Occupational Therapy Month comes Speech-Language Hearing Month in May. It's an opportunity to honor all who provide greater care not only to the patients of Oklahoma, but across the states. It also gives us the chance to raise awareness for communication disorders and the role of therapists in providing life-altering treatment.

Therapy FAQs

Q: How do I know if the member who is coming to my clinic is on a SoonerSelect plan?

A: If the member/caregiver did not choose a SoonerSelect plan, OHCA chose one for them. This applies if the member was in one of the mandatory populations. If the member is in one of the excluded populations, then the current OHCA system using the PA portal still applies. If the member is part of a voluntary population, they are in the current OHCA system unless they elected to opt into one of the SoonerSelect plans. To look up eligibility, submit a claim or check the status of a claim on the PA portal or on Availity, please review this guide.

Inquiries and issues beyond what is addressed in the guide can be directed to the OHCA Provider Helpline at 800-987-7767 or SoonerCareEducation@okhca.org.

Q: How do I become contracted with the three SoonerSelect plans?

A: Please review this fact sheet and contact each of the SoonerSelect health plans separately to begin the contracting process. You must be contracted with the SoonerSelect plans your patients have enrolled in to serve them. The sooner you do this, the quicker claims and reimbursements will be processed 

Q: Is there any training on filing a PA with the SoonerSelect plans?

A: The SoonerSelect health plans use a system called Availity, which will have functions similar to those of the PA portal that OHCA uses. To access training, please visit OHCA's provider training page.

Any questions regarding a PA request and its decision must be directed directly to the member’s respective SoonerSelect health plan. All amendment requests should also be directed directly to the member’s respective plan using their methodology. If a member is in the excluded/voluntary population, amendments should continue to be submitted via the PA portal, and questions can be directed to therapyadmin@okhca.org.

*Please note that the question below affects PA requests that have yet to change/transition. All providers must review the contents of the PA that still fall under SoonerCare policy.

Q: How will the SoonerSelect transition affect a retroactive request or a change of provider situation?

A. Retroactive request: To backdate any request to March 31, 2024, or before, please submit an amendment via the PA portal with all required documents, including a TEFRA award letter dated within the past 30 days of the submission. To backdate any request to April 1, 2024, or after, amendments should be directed to the respective SoonerSelect health plan using its methodology.

Change of provider situation: If a change of provider is effective with a new location start date of March 31, 2024, or before, then the PA process is unchanged for submission in the PA portal. If a change of provider situation is effective with a new location start date of April 1, 2024, or after, then submit the request to the member’s SoonerSelect plan using its methodology.

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