July 2024
OHCA is hosting onsite office hours to answer your SoonerSelect questions. Representatives from the SoonerSelect health plans and Children's Specialty Program will be at Oklahoma Health Care Authority from 9 a.m.-3 p.m., Friday, July 12. They will be ready to answer your SoonerSelect questions, so stop by to talk directly with a plan representative.
If you can't make it to the OHCA office, each of the plans continues to offer virtual office hours. Additional resources are available on OHCA's SoonerSelect provider page. These include prior authorization guides, an Availity crosswalk, FAQs, webinars and more. If you have questions, please email SoonerSelect@okhca.org.
Some providers use commercial market taxonomy codes to submit their SoonerSelect claims. Commercial market taxonomy codes do not match the OHCA taxonomy codes. This can cause delays and/or reimbursement denials for SoonerSelect submitted claims. To resolve this, compliance edits are needed to reduce the impact and disruption to your SoonerSelect billing operations.
OHCA is hosting two webinars to discuss these taxonomy compliance edits:
Wednesday, July 17 • 10 a.m. | Register
Wednesday, July 17 • 2 p.m. | Register
If you have any questions about compliance edits, please plan to join one of the webinars above. You can also view our provider letter that details how to update your data. Making these changes will facilitate timely provider reimbursement.
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, 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.
Using tobacco affects more than just physical health — it also impacts relationships, connections and overall well-being. This July, as we acknowledge Social Wellness Month, encourage your patients to strengthen their personal bonds by quitting tobacco.
Motivate your patients to focus on the things that matter such as:
- Family meals, memories and moments instead of smoke breaks
- Increased stamina to keep up with kids and grandkids
- Creating a healthy, smoke-free place to host loved ones
- More money for unforgettable experiences
- The freedom to go anywhere without worrying about smoking
Connect Your Patients with Free Quit Support
The Oklahoma Tobacco Helpline provides free services and resources to all Oklahomans thinking about quitting tobacco. Patients gain access to a supply of nicotine replacement therapy — patches, gum or lozenges — to help safely manage cravings and withdrawal symptoms. A personalized dashboard helps track progress and shipments throughout their quit journey and manages their goals. Additionally, the Helpline offers supportive coaching, text messages and emails for encouragement, and live online group sessions to give your patients a community.
Learn More About the Services
Looking for a way to start the conversation? Get free Helpline materials for your office such as pens, brochures, badge reels and prescription pads. Order your supplies now.
Friendly reminder when requesting initial orthodontic services: Please enter four lines of an orthodontic request. There is a helpful guide on the public dental page that shows you step-by-step how to enter requests.
Checking History
Keep in mind that even if the member is new to your office, it's always possible they've received treatment with a different provider. Therefore, please continue to check history before submitting prior authorization requests. The dental unit will return any request in which the member has already received services.
Claims Status
The dental unit will not be able to answer questions regarding claims status, reasons for claim denial, partial payments or recoups. These questions should be directed to provider services at 800-522-0114. The provider portal will also be helpful in determining reasons for claim denial/claim status.
However, if you are experiencing an issue with a claim that is specifically denied for “No PA on Database,” the dental unit can help. If it is found that the claim is denied for reasons other than an issue with a prior authorization, the inquiry will be directed to provider services.
Did You Know?
OHCA has a page devoted to dental services. It contains links to policy, the dental fee schedule, dental forms and other useful information. In addition, by logging into the provider portal, you can view items such as prior authorization status.
According to the Centers for Disease Control and Prevention, “Studies have confirmed that when people with type 2 diabetes are exposed to high levels of nicotine, insulin is less effective.” SoonerCare offers two benefits to assist members with these challenges: tobacco cessation medications and diabetes self-management services. Learn more and refer your patients today.
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According to the American Academy of Family Physicians and the March of Dimes, more than half of Oklahoma is considered a maternity care desert. And only 8% of Oklahomans eat the recommended amount of fruits and vegetables. With those two co-occurring challenges, it’s easy to see the importance of emphasizing good nutrition and prenatal vitamins for pregnant and postpartum members.
SoonerCare covers dozens of prenatal vitamins at no cost to female members who are 10 to 50 years of age, and they do not count toward monthly prescription limits. Many prenatal vitamins are available without prior authorization. SoonerCare also covers additional services for pregnant members in certain circumstances. For more information, visit the SoonerSelect health plan websites and utilize the resources within the provider portals. If you have questions about prenatal vitamins coverage or preferred prenatal vitamins, please call the pharmacy help desk associated with your patient’s health plan.
Oklahoma ABLE Tech helps providers connect to other Oklahomans for a direct device exchange. The Device Exchange Program can be used as a person-to-person exchange of equipment, which functions like a free online marketplace. ABLE Tech offers the ability to donate, sell, or locate reasonably priced equipment, such as wheelchairs, modified vehicles, lift chairs and other devices or supplies. Check often; the list changes daily. Search for a device.
Listing Equipment for Sale or Exchange
To list your durable medical equipment for sale or exchange, create an account in the exchange portal. Once your account is created, log in and click the "Add Classified Item Listing" button at the bottom of the page. Complete the Classified Item Entry form. Make sure to add a detailed description and pictures. Click "Save" and your listing will go to the Device Reutilization Program team for approval.
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Q: How do I approach seeing a member who was originally transitioned to a SoonerSelect plan with a contracted entity, and has now transitioned back to SoonerCare under OHCA?
A. If a member was transitioned to a SoonerSelect contracted entity (CE) and a PA request was approved by the CE before being transferred back to SoonerCare, then a new PA request needs to be submitted through the provider portal. Include in this PA request:
- The CE approval letter for the original PA request
- The evaluation and/or progress note that was originally submitted
- The HCA 61 PA request form
- The referring provider script
- The parental consent form
Please note that a new progress note will be required to validate continued medical necessity if significant time has elapsed since the originally submitted profession-specific note was completed.
If all documentation is provided, the new PA request will be approved effective the date member was transferred back to SoonerCare. Input the start date on the HCA 61 PA request form as the date of your submission and OHCA will backdate the request to the date the member was transferred back to SoonerCare.
OHCA will honor CE approved PAs for up to 90 days from the date the member was transferred back. For example, if a member was transitioned to a CE on April 1, 2024, then a PA was approved by them from April 2, 2024-Dec. 2, 2024. If the member was transferred back to SoonerCare on May 2, 2024, OHCA would approve the PA request from May 2, 2024-Aug. 2, 2024.
If a member was transitioned to a SoonerSelect CE with an active PA with SoonerCare, and then transitioned back to SoonerCare while the PA is still active, then no new PA request needs to be submitted. SoonerSelect CEs are bound to honor SoonerCare-approved PAs for up to 90 days. Accordingly, if the member was with a CE for six weeks before transitioning back to SoonerCare, then claims for services provided during that duration of time the member was with the CE need to be handled by the CE. Claims for the PA should be submitted to the OHCA for services delivered pre-transition to SoonerSelect and post-return to SoonerCare.
Q: What are OHCA’s requirements for timed and untimed CPT codes?
A: All providers need to follow the CMS guidelines for billing timed and untimed services for reimbursement by the OHCA. Please review this link to ensure ethical billing practices consistent with CMS.
Q: What is modifier 52 and how is it used?
A: Modifier 52 is used with 92523 when the articulation portion of the evaluation could not be completed. This modifier is typically used when a member is non-verbal or only has a few words. If a standardized test cannot be completed, then a narrative can be included in the evaluation instead. If no standardized articulation measure is used and a detailed narrative is not included, then modifier 52 must be added to indicate the evaluation could not be fully completed. Detailed narrative example:
“A standardized articulation test was not administered due to the patient's limited verbal output and difficulty naming nouns. A sound inventory was taken during the evaluation and is as follows: /a/, /e/, /i/, /o/, /u/, /k/, /b/, /p/, /m/. Using the listed phonemes and vowels, pt. is able to produce CV/VC/CVC/VCV, CVCV combinations including the following words: "car," "peppa," "mama" and "papa." Phonological processes of fronting and final consonant deletion noted. Clinician judges patient's speech intelligibility to be 50%. Patient is still mixing jargon with true words and currently presents with a moderate articulation delay.”
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