October 2024
Sept. 30, 2024, marked the end of the American Rescue Plan mandate to cover without limits and copays the following COVID-19-related services:
- Vaccine administration
- Testing including self-collected tests
- Treatment
- Treatment for conditions that may seriously complicate COVID-19
Effective Oct. 1, 2024, with the exception of vaccine administration, member copays as applicable reverted to pre-COVID-19 amounts. Reimbursement for COVID-19 vaccine administration and treatment no longer includes enhanced reimbursement and has reverted to pre-COVID-19 amounts. Self-collected or at-home COVID-19 tests are no longer covered.
Please update your Oklahoma Health Care Authority (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 (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.
OHCA has extended the expiration date of physicians from Sept. 30, 2024, to Oct. 31, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members. There are currently more than 18,000 physicians who have yet to renew their Oklahoma Medicaid contract. To avoid any delay in reimbursement, physicians are encouraged to submit renewals as soon as possible. You can log into the provider portal to complete your renewal. If you need assistance logging into the provider portal, please contact our internet helpdesk at 800-522-0114, option 2, option 1. Or email SoonerCareInternetHelpdesk@gainwelltechnologies.com.
For the following provider types, 75-day renewals started Aug. 17, and contracts expire Oct. 31, 2024.
- Adult day services
- Agency companion services
- Architectural modifications
- Community transition services
- Daily living supports and intensive personal supports
- DDSD registered nurse
- Employment services
- Family counseling services business
- Family training
- Foster care
- Free-standing dialysis center
- Group home services
- Habilitation training specialist
- Home health skilled nursing services
- Homemaker services
- Medicare crossover claims
- Respite service
- Transportation business/individual/public
- Treatment parent specialists (QBH I/II)
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.
More than 75% of SoonerCare members are not aware that diabetes education is a covered benefit. You play a vital role in empowering patients with diabetes to manage their condition.
SoonerCare members can receive 10 hours of training during their first year of diabetes education. Each subsequent calendar year, members are eligible for two hours of individual or group instruction. This will give your patients the tools to effectively control their diabetes.
For more information, watch the DSMES and Medical Nutrition Therapy webinar by SoonerQuit. Together, we can improve health outcomes and enhance diabetes literacy.
If you're seeking to provide diabetes self-management education and support (DSMES) services, you must meet qualifications and complete the DSMES-specific enrollment process, which includes:
- Enrolling in the specific DSMES program as a diabetes self-management group.
- Enrolling each specific provider as a diabetic educator, connecting them to the DSMES program.
DSMES providers must complete the DSMES-specific process even if they are already an enrolled SoonerCare or SoonerSelect provider. If you have any contract questions, please contact provider enrollment at 800-522-0114 or ProviderEnrollment@okhca.org.
In addition to diabetes education, SoonerCare also covers continuous glucose monitors for qualifying members at the pharmacy point of sale. Some members may require a prior authorization. Additionally, SoonerCare covers 90-day fills of many diabetes maintenance medications.
Diabetes medications for weight loss are not currently covered by SoonerCare.
To find a contracted DSMES provider near you, choose “Diabetes Self Management” from the Specialty dropdown menu on the Provider Search page. If you have questions about a particular medication, diabetes testing supplies, or other pharmacy benefit questions, please call the Pharmacy Help Desk associated with your patient’s health plan.
Do your patients know the connection between smoking and Type 2 diabetes? National Diabetes Awareness Month is around the corner, so now is a good time to talk to your patients about the connection. Patients who smoke have a 30-40% higher risk of developing Type 2 diabetes than nonsmokers. This alarming statistic might help convince your patients to quit tobacco. Tobacco users with diabetes also have a higher chance of:
- Heart disease
- Kidney disease
- Poor blood circulation
- Nerve damage in the arms and legs
- Eye disease linked to blindness
Additionally, nicotine increases blood pressure and hardens blood vessels, which makes insulin less effective in people with diabetes. This means smokers with diabetes might have to increase their insulin dose to maintain their blood sugar level, which is more expensive.
Your patients trust your expertise. Recommend the Oklahoma Tobacco Helpline’s free resources and support for Oklahomans quitting tobacco. Resources include free coach support, nicotine replacement therapy like patches, gum or lozenges and an interactive dashboard to track goals. Even if you’ve talked to your patient about the Helpline before, mention it again! You never know when your patient will decide enough is enough with tobacco.
Order pens, brochures, badge reels and posters for your office at OKhelpline.com/order.
-
Opening of D2929 for Billing
Effective Aug. 15, 2024, OHCA has opened coverage for D2929 (prefabricated porcelain/ceramic crown — primary tooth). D2929 is covered for TXIX, HAP and CUST members ages 0-20 with no prior authorization required. Pricing is set at $121.95. Coverage and pricing changes will be added to the online dental fee schedule with the next scheduled quarterly update.
-
Dental Page on the Public Website
OHCA has a page devoted to dental services that contains links to policy, dental fee schedules, dental forms and other useful information, such as an amendment tutorial. By logging in to the provider portal, you can view items such as prior authorization status and access amendment submissions.
-
Provider Resource Page
The OHCA provider page offers many helpful links and tips. You'll find information on contracting, training, claim tools, policies, publications, SoonerSelect and a link to the provider portal.
-
Dental Plan Contact Information
DentaQuest: 833-479-1007 or okproviders@dentaquest.com
LIBERTY Dental: 888-902-0342 or okprinquiries@libertydentalplan.com
-
Contacting Your Provider Education Specialist
Providers may request assistance from a provider education specialist by emailing SoonerCareEducation@okhca.org. For immediate assistance with claim research or resolution of other Oklahoma Medicaid issues, contact the OHCA call center at 405-522-6205 or 800-522-0114.
Q: Do I need to add modifier 52 for my speech therapy evaluation request?
A: Along with modifier GN used for all speech-language pathology services, modifier 52 should also be included in the original evaluation request if any of these scenarios leading to a reduced evaluation applies:
- Child is non-verbal or can say only a few words (age or diagnosis related)
- Formal assessments cannot be entirely performed or completed
- Time constraints limited a comprehensive evaluation
- Patient participation limited the evaluation
- A detailed articulation summary (separate to parent report) is not included (see example here)
Before the patient is evaluated: If it is known that any of the above scenarios will apply based on the doctor’s visit note, then modifier 52 should be added on the HCA-61 form prior to an evaluation PA request for either CPT code 97522 or 97523. After the patient is evaluated: If the evaluation performed was not comprehensive and a detailed articulation summary could not be included, then an amendment will need to be submitted for the original PA request for 97522 or 97523 before any PA submission for speech therapy treatment can be approved. Once an amendment to the original evaluation PA request to add modifier 52 is approved, then the treatment PA request can be appropriately reviewed.
When do I need to add modifier 59 for speech therapy?
Modifier 59 is used to indicate that a procedure or service was independent from another procedure or service performed on the same day by the same provider. For the current OHCA-approved list of speech-language pathology CPT codes, this pertains to the use of 92609 and 92507 on the same day by the same provider. If the speech-language pathologist of record plans to provide both types of treatments on the same day, then CPT 92609 should be listed on line A with modifier GN, and CPT 92507 should be listed on line B with modifier GN and modifier 59 as secondary. This will ensure proper reimbursement for the distinct services performed on the same day. Please review this article by ASHA for additional information on this topic.
Why is my transfer-back PA request getting system canceled?
As patients are transitioning to SoonerSelect contracted entities, some will transfer-back to SoonerCare with OHCA. When this occurs, you can request a backdated approval if all applicable documentation can be provided. This will account for the gap in coverage during the transfer-back period. OHCA will honor an approved SoonerSelect PA request from the date of transfer-back to OHCA up to the original end date of the request and not to exceed a period of 90 days.
When submitting a transfer-back PA request, it's important to note that entering a historic start/from date on the PA portal will lead to a system cancellation. Accordingly, you must enter the start/from date on the PA portal as the present date of your submission and the end-date not exceeding a duration of 90 days. You should write the backdated timeline on the HCA-61 form, which you must submit. This crucial step will help avoid a system cancellation and allow the transfer-back PA request to be reviewed by the profession-specific reviewer.
Oklahoma ABLE Tech's Device Reutilization Program is working to make improvements. They are updating the criteria for acceptable device donations.
The goal is to ensure that all donations are of high enough quality for use. In the future, the program will now only accept gently used durable medical equipment (DME). That will enable more quality equipment to get into the hands of people who need it.
The following donations will no longer be accepted:
- Equipment that is torn, unrepairable, outdated, rusty or in otherwise poor condition
- Liquids of any kind – including dialysis solution and feeding supplements
- Syringes or needles
- Medications
- Opened or partly used supplies
- Mattresses or non-therapeutic pillows/bedding
- Oxygen concentrators, tanks or tubing
Individuals who have items in poor condition or from the above unacceptable categories can consider donating to Medical Supplies Network in Tulsa, which provides medical supplies to underdeveloped countries. Another option is local scrap yards for unrepairable metal equipment
If there's an item they're unsure about, they can call ABLE Tech at 405-967-6010 or text images to 833-751-9128. For a list of commonly requested DME, visit the ABLE Tech website.
Desired DME Donation Examples
LEFT: The transport wheelchair is in excellent condition. There are no tears on the cushions, the wheels are in good shape and move freely.
RIGHT: The easy glide stander has been well-maintained. The cushions, straps and hardware are in good condition.
Undesired DME Donation Examples
LEFT: The transport wheelchair is in excellent condition. The cushions have no tears, and the wheels are in good shape and move freely.
RIGHT: The hardware and mechanisms on this device are rusty and distressed.
|
