August 2024
Oklahoma Medicaid members enrolled in a SoonerSelect plan must still call or log in to MySoonerCare.org to make changes or updates to their application (income, address, household member changes, etc.). Members who receive their eligibility for benefits through Oklahoma Human Services should contact Human Services to update this information.
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.
For the following provider types, 75-day renewals started July 17, and contracts expire Sept. 30, 2024.
- Physician
- SUD residential
- OP SUD
- OTP
- Halfway house
- Medically supervised withdrawal management
Please be sure the contact information, including email address, is current for all individual and facility/group provider files so you can quickly receive important contract information.
Your patients trust your expertise. One of the best things you can do for their health is encourage them to quit tobacco. When you talk with your patients about quitting, it's important to prepare them for the challenges ahead. Here are some common withdrawal symptoms and coping strategies to share:
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Anxiety and Irritability: Short bursts of exercise and breathing techniques. Patients can also use the Oklahoma Tobacco Helpline to talk with a coach for in-the-moment support.
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Insomnia or Sleep Problems: Avoid caffeine after noon, exercise regularly and maintain a consistent sleep schedule.
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Restlessness: Light cardio and new hobbies like baking, knitting or gardening. Productive tasks, such as cleaning, can also ease restlessness.
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Increased Hunger: Consume more fruit, veggies and other healthy foods; drink water; and carry sugar-free gum or toothpicks. Nicotine replacement therapy (patches, gum or lozenges) can also help with cravings.
Connect Your Patients with the Oklahoma Tobacco Helpline
The Oklahoma Tobacco Helpline offers free resources to all Oklahomans thinking about quitting tobacco, including:
- Patches, gum or lozenges to fight cravings fast
- Encouraging coaching support to provide tips when your patients need them most
- Supportive text messages and emails with actionable tips and advice
- Live online group sessions where your patients can connect and chat with peers
- A personalized dashboard to track progress, healthy habits and nicotine replacement therapy shipping status
Your recommendation may be the final push your patients need to start their quit journey. Encourage them to check out the free services to find what works. And don't forget to get free Helpline materials for your office, such as pens, brochures, badge reels and posters.
Dental Services Web Page
The Oklahoma Health Care Authority has a page devoted to dental services. It contains links to policy, dental fee schedule, dental forms and other useful information such as an amendment tutorial. In addition, by logging into the provider portal, you can view items such as prior authorization status and access to amendment submissions.
Check History
Keep in mind that even if a member is new to your office, it's always possible they have received treatment with a different provider. Therefore, please continue to check history before submitting prior authorization requests. The dental unit will return any request for services the member has already received.
Prior Authorization Submission
To expedite the initial review of prior authorizations, please ensure the authorization has been entered correctly, keeping in mind that a claim submission must match the authorization. For example, initial partial and denture requests that have quadrants entered will be returned to the provider, citing input error. In addition, please review the policy listed below regarding removable prosthetics:
OHCA Policies and Rules Main Page
317:30-5-698. Services requiring prior authorization.
(1) Removable prosthetics.
(A) This includes full and partial dentures.
(i) One (1) per every five (5) years is available for adults under twenty-five (25) years of age.
(ii) One (1) per every seven (7) years is available for adults twenty-five (25) years of age and over.
(iii) Provider is responsible for any needed follow-up for a period of two (2) years post insertion.
Did You Know?
You can visit OHCA's Global Messages page to subscribe to web alerts. You can also view all current and previous provider updates.
Mavyret® (glecaprevir/pibrentasvir) is currently SoonerCare’s only preferred direct-acting antiviral (DAA) medication for the treatment of HCV. It is available without prior authorization as part of an initiative by OHCA to cure HCV in the SoonerCare population.
For other DAAs, the PA criteria are still in effect, and PA forms are still required. Additionally, PA requests for other DAAs require a patient-specific, clinically significant reason 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:
- The medication-specific PA form (e.g., Harvoni®, Pharm-33)
- Hepatitis C Therapy Intent to Treat Contract form (i.e., Pharm-28)
- 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).
Prescribers are encouraged to follow current guidelines and Mavyret prescribing information when initiating testing for HCV, selecting an appropriate treatment regimen, and performing all necessary monitoring. Before initiating therapy for HCV, prescribers are encouraged to verify that the member's SoonerCare eligibility is in effect long enough to complete treatment. All HCV patients should be monitored for compliance and counseled regarding the importance of compliance and finishing treatment.
Anti-Diabetic Medication Shortage Update
Recent shortages of multiple GLP-1 agonists have persisted. As a reminder, higher-tiered medications will not be approved solely due to shortage or supply issues. Members must still meet current clinical prior authorization criteria to be considered for higher-tiered medications. Current Tier-2 GLP-1 agonists include Victoza® (liraglutide), Trulicity® (dulaglutide), and Byetta® (exenatide).
Prescribers may also consider prescribing a Tier-1 or Tier-2 DPP-4 inhibitor, as their mechanism of action is very similar to the GLP-1 agonists. Current Tier-1 DPP-4 inhibitor-containing products include empagliflozin/linagliptin (Glyxambi®) and empagliflozin/linagliptin/metformin ER (Trijardy® XR). Current Tier-2 DPP-4 inhibitors and DPP-4 inhibitor-containing products include linagliptin (Tradjenta®), linagliptin/metformin (Jentadueto®), linagliptin/metformin ER (Jentadueto® XR), sitagliptin (Januvia®), sitagliptin/metformin (Janumet®), sitagliptin/metformin ER (Janumet XR®). Pharmacy PA forms can be found on the OHCA website.
Pharmacy Questions
For questions about pharmacy benefits for members covered by SoonerCare, contact the SoonerCare Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.
For questions about pharmacy benefits for members covered by SoonerSelect, please contact the pharmacy help desk associated with your member’s health plan or email SoonerSelect@okhca.org.
Oklahoma ABLE Tech’s Device Reutilization Program recently received a significant donation containing various pieces of pediatric durable medical equipment.
This generous contribution enhances the program’s capacity to support children with medical needs by providing them with essential equipment. Available equipment includes but may not be limited to:
- Pediatric gait trainers*
- Pediatric manual wheelchairs
- Pediatric shower chairs
- Pediatric standers*
- Pediatric walkers*
Some of this equipment (marked with *) may require standard documentation requirements, which will be indicated on the application. If any of these devices may fit your needs, submit an online DME application to start the reassignment process. DME will be distributed on a first-come, first-served basis via complete applications received.
ABLE Tech's Device Reutilization Program is dedicated to sanitizing, refurbishing and reassigning donated DME to ensure it meets the needs of the best-matched recipients across Oklahoma at no cost. This program operates in coordination with the Oklahoma Health Care Authority.
Q: What is an appropriate handoff in a communicated change of provider situation?
Regarding PT/OT services: A patient/caregiver may change a service location for several reasons. Regardless of why they change, a handoff must provide an accurate patient status summary to the next provider to resume care. Accordingly, a progress note must be performed on the last known day the patient is seen at a clinic. It should be provided to the patient’s next clinic along with the initial evaluation and referring provider script. The progress note must address the patient’s current, up-to-date status and justify the continued need for services by providing a commentary on goal progress for each established goal tied to subjective/objective remeasurements.
Since OHCA reimburses an initial evaluation once every year for PT/OT, it's important to follow this process. When the new location submits a new PA request, they must include the progress note, a statement by the new therapist of record approving the established plan of care, the HCA 61 form, parental consent form, change of provider form, and referring provider script.
Depending on how long the gap in care provision is between old and new locations or if the need to transfer clinics was not communicated, the new location will be required to perform their own progress note visit to provide an accurate, up-to-date summary of the patient’s status before the PA request submission. Services are reimbursed through their start date. Thus, if a progress note was to be performed by the new clinic on Oct. 1, 2024, and the PA request was timely submitted on Oct. 1, 2024, then services provided on this day would be reimbursable if the PA request is approved.
Regarding SLP services: If a change of provider situation occurs within six months of the last evaluation, the new clinic must provide a statement of approval of the established plan of care, the previous clinic’s evaluation, the referring provider script, the HCA 61 form, change of provider form, and parental consent form. If a six-month timeframe has passed since the last evaluation was completed at the previous clinic, the new clinic can request a PA for its own evaluation.
Q: What are the rules for coverage when providing therapy services to SoonerCare members ages 21 and above?
A: Each member is entitled to 15 visits for PT, OT and SLP per year. These must be held in a hospital-based outpatient clinic and do not require a PA request. The only exception to this is for PT services involving a spinal diagnosis, which is allowed under the alternative treatments for pain management program. If a spinal diagnosis is involved, up to 48 units of PT services can be approved yearly in a nonhospital-based outpatient clinic following the submission of a PA request. View the guidelines.
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