December 2024
As we step into a new year, it’s the perfect opportunity to encourage your patients to prioritize healthier habits. Did you know that SoonerCare members are eligible for up to six hours of free nutritional counseling per year with a licensed registered dietitian?
Here’s how you can help your patients:
- Provide access to personalized nutrition plans
- Offer expert guidance for healthier choices
- Support them in managing chronic conditions
Whether your patients are looking to eat healthier or need assistance managing a chronic condition, SoonerCare’s medical nutrition therapy benefits provide professional support tailored to their needs.
Together, we can improve health outcomes of Oklahomans.
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 Nov. 31, 2024, to Dec. 30, 2024. This will allow provider enrollment time to process incoming renewals without interruption of services to members. There are currently more than 13,000 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 Oct. 17, and contracts expire Dec. 31, 2024.
- Free-standing dialysis center
- Medicare crossover claims
- Treatment parent specialists (QBH I/II)
- Occupational therapy assistant
- Physical therapy assistant
- Speech pathology assistant
- Speech pathology clinical fellow
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.
The holidays can be tough for your patients who are trying to quit or have recently quit tobacco. As their health care provider, you play a major role in their quitting journey. Understanding how your patients are feeling can make a huge impact. Here are four things to remember when talking with your patients this holiday season:
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Cessation services work. Resources such as nicotine replacement therapy, coach support and communication are proven, effective ways to quit tobacco.
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Cold turkey isn't enough. Two in three people try to quit tobacco without help. Encourage your patients to take a new approach with the Oklahoma Tobacco Helpline.
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Stress can make triggers worse. Pass along stress-management tips to help your patients get through the holiday anxiety, such as:
• Setting clear boundaries with family and friends.
• Maintaining healthy sleep habits.
• Eating healthy.
• Finding moments for self-care.
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Every conversation counts. You are often your patients’ voice of reason and biggest cheerleader. Talking with your patients about quitting and encouraging them along the way may be the boost they need to succeed.
If you need quit resources for your patients, the Oklahoma Tobacco Helpline offers free support, including patches, gum or lozenges; coaching support, encouraging texts and emails; and live online group sessions. Free office materials are also available for your practice. Order clipboards, badge reels, prescription pads and more at OKhelpline.com/order.
The FDA has now approved three products for the prevention of lower respiratory tract disease (LRTD) due to respiratory syncytial virus (RSV). The RSV vaccines Arexvy and Abrysvo™ are approved for the prevention of LRTD caused by RSV in individuals 60 years of age and older. Abrysvo also carries an expanded indication to include pregnant individuals at 32 weeks through 36 weeks gestational age for the prevention of LRTD and severe LRTD caused by RSV in infants from birth through age 6 months.
For pediatric patients, Beyfortus® (nirsevimab-alip) is FDA-approved for the prevention of LRTD due to RSV in neonates and infants born during or entering into their first RSV season. It is also approved for children who remain vulnerable to severe RSV disease through their second RSV season. Recent statements from the American Academy of Pediatrics (AAP) recommend all infants eligible for nirsevimab should receive nirsevimab. Synagis® (palivizumab) should now only be administered to eligible high-risk patients if nirsevimab is unavailable.
The Advisory Committee on Immunization Practices (ACIP) recommends 1 dose of nirsevimab for all infants younger than 8 months of age born during or entering their first RSV season. ACIP also recommends that nirsevimab be given to children 8-19 months of age who are at increased risk of severe RSV disease and entering their second RSV season. Nirsevimab does not require prior authorization (PA); however, SoonerCare members must receive nirsevimab through the VFC program. Approval of palivizumab requires a patient-specific, clinically significant reason why the member cannot receive nirsevimab in addition to its current PA criteria which are based on AAP guidelines. Additionally, the prescriber must confirm the member has not already received nirsevimab for the current RSV season. Concomitant use of both palivizumab and nirsevimab will not be approved.
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 800-522-0114, option 4.
For questions about pharmacy benefits for members covered by SoonerSelect, contact the pharmacy help desk associated with your patient’s health plan or email SoonerSelect@okhca.org.
Do I still need to submit a PA request if Medicaid is not the patient’s primary coverage?
Medicaid is always the payor of last resort. When Medicaid is a secondary form of coverage for a patient, it is still recommended that a PA request be submitted with all required documentation for all PA-requiring services. This ensures continuation of coverage whenever a primary insurance stops covering a service for any reason.
Do I need to fill out all the blanks on the required forms?
All OHCA forms must be filled out entirely with the correct information tied to the member RID number. Not filling out the forms entirely or correctly will result in a cancelation. Information provided via submitted forms (HCA-61 parental consent or SC-10 referral) should always match the member’s profile with the OHCA to ensure proper PA and claims processing. When there is a discrepancy, alert the patient/family and have them contact the OHCA helpdesk as soon as possible to get this information corrected.
Is a referring provider signature needed on the progress note if a script has already been given? A script is always needed for the initial authorization request involving an evaluation note (yearly). The subsequent times you submit for a PA (within the year), that same script would be valid if it is an eval and treat script (valid for 12 months from the date of signature). If this original script had specific parameters (like 2x/6 weeks or 12 sessions), then one of two things is needed:
- A new script.
- A referring provider signature on the progress note/re-eval that is being submitted.
If the new script has set parameters, they should be followed. If a referring provider signature is derived on the progress note/re-eval, then this will function as an eval and treat script for the request.
What is required in a TEFRA retroactive PA request? When initiating services in anticipation of coverage being granted at a later date, the rendering clinic is responsible for ensuring the timely acquisition and completion of all required documentation. A TEFRA award letter grants a member retroactive eligibility. However, coverage for any service delivered in this retroactive period is still reliant on the provision of all required documentation. Clinics should be aware and stay in communication with the family regarding the arrival of the TEFRA award letter, as the retroactive PA request needs to be submitted timely upon receipt of this letter via mail. To get visits backdated, the rendering clinic is responsible for the timely provision of all required documentation below:
- For PT/OT: A progress note or evaluation completed within 30 days before the historic start date. Routine progress notes will be necessary to ensure that a good record is maintained. For SLP: An evaluation or progress note that was completed close to the historic start date.
- This requirement is to show the continued need for services beyond the present date. For PT/OT: A current, up-to-date progress note on the patient (this note should be within the past 30 days of your current submission date). For SLP: a recently completed progress note.
- The TEFRA award letter (submission for this PA request should occur in a timely manner following the acquisition of this required document).
- Parental consent form (must be signed/dated before the historic start date. However, it does not need to be an OHCA-specific consent form).
- Rx for services (must be signed/dated before the historic start date).
- HCA 61 form (filled out accurately to reflect all needed services for coverage with consideration to the retroactive and future timeline).
You can now search the available Device Reutilization Program inventory again! Those interested in applying can view the gently used durable medical equipment (DME) and assistive technology (AT) available through the Reutilization and Exchange programs.
Device Reutilization Program
Device reutilization items include the donated items that Oklahoma ABLE Tech staff retrieve, sanitize and refurbish. These devices are matched through an application process to the best-matched Oklahoman. Any Oklahoman in need of medical equipment or devices, regardless of income, is eligible for the program. However, priority is given to SoonerCare members.
When you’ve decided what type of DME will fit your needs, complete the application for durable medical equipment. Staff will match you with equipment based on the details in your application. You cannot request specific items from the inventory. Also, most images in our inventory are stock images of common DME, not photos of the exact piece of equipment listed.
Device Exchange Program
Items listed in the device exchange are meant to connect Oklahomans to one another for a direct exchange. The exchange program functions like a free, classified, online marketplace. Oklahoma ABLE Tech can help you donate, sell or locate equipment such as wheelchairs, modified vehicles, lift chairs, and other devices/supplies for a reasonable price.
To navigate the exchange portal, you can search by device type or device category (speech, hearing, vehicle modification, mobility, etc.), or use a keyword search for the item you are looking for. For example, say you’re looking for a modified vehicle. Navigate to the reutilization inventory search and enter “van” in the search field. This will pull up any available matching items. See the example below.
Then contact the person or organization in the “Listed By” section to ask more questions or schedule the purchase. Check back often, as the exchange list changes frequently!
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