June 2024
The SoonerSelect continuity of care period will end on June 30, 2024. It is critical that you verify that all prior authorizations (PAs) for your SoonerSelect patients have been successfully processed with the patients’ plans. SoonerSelect plans will process PAs through their internal processes and secure provider portals on Availity. Please contact the health plans directly with training needs or questions on PAs.
Additionally, when the continuity of care period ends, you must be an in-network provider with the plan(s) to receive reimbursement at 100% of the Medicaid rate.
Virtual Office Hours
As a reminder, representatives from the SoonerSelect health plans are continuing to hold virtual office hours to answer your questions. Visit the provider resources page and look for the virtual office hours links. This section is updated continually.
Be sure to bookmark the SoonerSelect provider page; new resources are continually being added. The provider training page includes a list of upcoming SoonerSelect webinars. If you have questions, please email SoonerSelect@okhca.org.
Please update your OHCA provider files to ensure all details, including new or missing locations and group member assignments, are accurate. If your update impacts services under SoonerSelect partners, please email your Application Tracking Number (ATN), received upon submitting your update on the OHCA provider portal, to providerenrollment@okhca.org with "SoonerSelect update" and your Application Tracking Number in the subject line.
The following provider types will be opening for renewals later this year:
| Contract |
75-Day Renewal Starts |
Contract Expires |
| Physician |
July 17, 2024 |
Sept. 30, 2024 |
| SUD Residential |
July 17, 2024 |
Sept. 30, 2024 |
| OP SUD |
July 17, 2024 |
Sept. 30, 2024 |
| OTP |
July 17, 2024 |
Sept. 30, 2024 |
| Halfway House |
July 17, 2024 |
Sept. 30, 2024 |
| Medically Supervised Withdrawal Management |
July 17, 2024 |
Sept. 30, 2024 |
Please be sure the contact information, including email address, is up to date for all individual and facility/group provider files so that important contract information will be received.
Are your patients struggling to add more color to their daily meals? We know that consuming a variety of fruits and vegetables promotes better health, assists maintaining a healthy weight and helps fight disease.
SoonerCare offers medical nutrition therapy (MNT) services to our members. Registered dietitians create an individualized plan to help your patients learn and practice healthier nutritional habits. Learn more about the nutrition benefit and refer your patients today.
In the wake of devastating tornadoes and storms, many victims were left without shelter, belongings, and crucial medical equipment. Oklahoma ABLE Tech, a key participant in the Oklahoma Disaster Plan, steps in during these critical times to provide durable medical equipment (DME) to those in emergency need.
Donate your gently used medical equipment to ABLE Tech. Your contributions can make a significant difference in the lives of disaster survivors, offering them the support and tools they need to move forward.
Have you lost or damaged medical equipment? If you or someone you know has been affected by recent tornadoes and storms and has lost or suffered damage to durable medical equipment, help is available. Please reach out to ABLE Tech at 405-967-6010.
Q: What do I need to submit every time for a therapy PA request?
A: For initial requests, four main legible documents are necessary including:
- Referring provider script with a dated signature (OHCA SC-10 referral form).
- Completed HCA SC-15 parental consent form.
- Completed HCA-61 therapy prior authorization request form.
- Informative profession-specific evaluation note justifying medical necessity with the therapist’s dated signature.
For subsequent requests, a few changes may need to be made for the same four documents.
- The same referring provider script may be valid if it was dated for a 12-month period. If not, a new script is needed or the profession-specific progress note being submitted needs to be signed by the referring provider.
- A signed profession-specific progress note is necessary with subjective and objective remeasurements tied to a commentary on current level of progress for each listed goal. Progress to date needs to be elaborated or the lack of progress needs to be explained to validate continued need for services.
- The parental consent form also needs to be included and is valid for 12 months from date of parent/guardian signature to ensure that the treatment plan is agreed upon at least annually.
Lastly, a new HCA-61 form needs to be submitted with the request being consistent with the referring provider script (if specified) and the plan in the profession-specific note.
Q: Can I submit an amendment request to extend the authorization timeline, add line-items, add CPT code units, or change CPT codes?
These are all valid reasons to submit an amendment request to an existing PA. However, there are documentation requirements that need to be met for these amendments to be processed.
- To amend an approved PA, we require submission of an HCA-60 Prior Authorization Amendment Form filled out in its entirety where applicable.
- If more than 30 days have passed since the PT or OT note submitted on the existing PA was performed, then a progress note will be required. Progress notes will be required to ascertain continued medical necessity after a 30-day period.
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Parental consent forms and eval-and-treat referral scripts are valid for a 12-month period; therefore, it is important to keep in mind the dates on these forms.
If the referring provider script has set parameters listed, such as 2 times per week for 6 weeks (12 sessions), then amendments need to remain consistent with this, or a new referring provider script must be provided.
Q: Can I submit an amendment to a PA request after the end date of the request?
A: For any form of additional coverage, a new PA request can be submitted with all required documentation after the end date of the authorization.
Amendments for extending the end date, adding line-items, adding CPT code units, or changing CPT codes need to occur during the authorization timeline. Retroactive requests for additional coverage will not be approved.
If claims have been paid, then CPT codes cannot be changed for the paid dates of service but can be changed after.
With the transition of many members to SoonerSelect, you may be wondering how pharmacy benefits have changed.
Many components of the pharmacy benefit are the same:
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Prior Authorizations (PAs): Approval criteria are the same for both SoonerCare and SoonerSelect medication coverage.
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Drug Utilization Review (DUR) Board: The decisions of the DUR board establish the PA criteria. Meetings are open to the public and are held on the second Wednesday of each month. Criteria are updated following DUR board approval.
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Covered Over-the-Counter Products: Specific medications and classes are unchanged; however, specific NDC coverage may vary by plan.
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Diabetic Testing Supplies: Criteria for coverage is unchanged; however, specific NDC coverage may vary by plan.
- Several classes of commonly used medications do not count toward a monthly prescription limit for SoonerCare and SoonerSelect members; however, PA criteria may apply to specific medications or to specific NDCs*:
- Tobacco cessation products
- Prenatal vitamins
- Contraceptives
- Vaccinations
- HIV treatment
- Chemotherapy
- Buprenorphine
- Naloxone
- Medications that require frequent monitoring
*Additional medications not listed may not count toward a monthly prescription limit.
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Brand-Preferred Medications: SoonerCare and SoonerSelect members require a patient-specific, clinically significant reason to use the generic versions of these medications.
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Maintenance Drug List: These medications can be prescribed for a 90-day supply for SoonerCare and SoonerSelect members; however, PA criteria may apply to some specific medications.
Some components will vary by plan:
- NDC Coverage: Specific NDC coverage may vary, as noted above.
- Forms: SoonerCare forms are used exclusively for SoonerCare members. SoonerSelect forms are used for members of their respective plans.
- Help Desk: SoonerCare Pharmacy Help Desk is used exclusively for questions regarding SoonerCare members. SoonerSelect contact numbers are used for questions regarding members of their respective plans.
- CoverMyMeds (CMM): CMM should not be used to submit SoonerCare PAs. The use of CMM to submit SoonerSelect PAs may vary by plan.
- Prescription Limit: The number of covered prescriptions per month for SoonerCare members is unchanged. The number of covered prescriptions per month for SoonerSelect members may vary by plan.
For SoonerCare prescription benefit questions, please contact the SoonerCare Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.
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