January 2025
February marks American Heart Month, a vital time to help patients focus on heart health and nutrition. SoonerCare offers members up to six hours of free Medical Nutrition Therapy per year with a licensed registered dietitian.
Why Recommend MNT for Heart Health?
- Tailored meal plans to manage hypertension and cholesterol
- Nutrition guidance to prevent cardiovascular disease
- Support for patients making long-term dietary changes
As a trusted provider, you can help patients take meaningful steps toward better heart health by connecting them with MNT services.
Encourage your patients to ask if they qualify, and let’s work together to promote healthier hearts this February and beyond!
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 Dec. 31, 2024, to Jan. 31, 2025. This will allow provider enrollment time to process incoming renewals without interruption of services to members. There are currently more than 12,000 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 Jan. 31, 2025.
- Occupational therapy assistant
- Physical therapy assistant
- Speech pathology assistant
- Speech pathology clinical fellow
For the following provider types, 75-day renewals start Jan. 15, and contracts expire March 31, 2025.
- Hospital
- ITU contracts
- Optician
- Optometrist
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.
Dental Unit Phone Number
To better serve our members, please direct their questions or concerns to Member Services at 800-987-7667 rather than the dental line voicemail. In addition, when leaving a message for the dental unit, please ensure to leave a working number. Provider inquiries may also be made by emailing DentalServices@okhca.org.
Provider Portal
For assistance with the provider portal, please contact our internet helpdesk at 800-522-0114, option 2, option 1, or by mail at SoonerCareInternetHelpdesk@gainwelltechnologies.com.
Contacting Your Provider Education Specialist
Providers may request assistance from a provider education specialist by emailing SoonerCareEducation@okhca.org.
Member Eligibility
Please ensure you check member eligibility on the day of the member’s appointment. Be sure to note whether the member has a dental benefit plan.
A prior authorization does not guarantee payment, and if services are rendered for a member that does not have eligibility or prior approval, those services must be written off. The member will not be responsible.
D7210 Surgical Extractions
Dental providers must comply with the American Dental Association’s (ADA) Current Dental Terminology (CDT) when billing for surgical extractions, D7210. Providers must clearly document the medical necessity for the surgical extraction, supported by radiographic images and clinical narrative(s) in the patient’s medical record.
After review of historical billing practices for D7210 in the SoonerCare program, OHCA observed a history of misapplication and/or erroneous coding practices for this code. Effective June 1, 2024, OHCA approved modified guidelines and changes for both SoonerSelect dental plans, DentaQuest and LIBERTY Dental, as it pertains to D7140 and D7210. Please refer to provider letter 2024-11, which outlines the approved modified guidelines in detail.
Effective June 1, 2024, the SoonerSelect dental plans began implementing modified prepayment reviews for D7210. If modified prepayment review of D7210 finds insufficient clinical documentation and/or evidence of the need for surgical extraction, the dental plans have OHCA approval to down-code the service to a D7140.
OHCA and the SoonerSelect dental plans will continue to monitor billing practices for D7140 and D7210 in both the SoonerSelect dental and the SoonerCare fee-for-service programs. Providers who consistently demonstrate a pattern of misapplication of these CDT codes may be subject to recoupments and/or referral(s) for investigation into fraud, waste and abuse.
Denture Adjustments, Tissue Conditioners and Relines
Concerning dentures, adjustments, tissue conditioners, and relines, OHCA protocol states a provider is responsible for denture maintenance and feasibility for 24 months (2 years) from delivery. The provider must deliver a prosthesis that is reasonably functional and esthetically presentable. Any adjustments or additions (e.g., tissue conditioners) associated with the initial delivery and within 24 hours of delivery are included in the initial reimbursement and are not separately billable. All adjustments and/or tissue conditioners done on the same date of delivery cannot be charged separately and are all included in the denture fee.
Separate billing is allowed for adjustments (using appropriate CDT codes D5410, D5411, D5421 or D5422) performed after the delivery of the prosthesis up to three times per arch per 12 months. Additionally, separate billing is allowed for tissue conditioner (using appropriate CDT codes D5850 or D5851) if documentation supports the service is medically necessary for healing, tissue changes or to facilitate proper fit and function. Adjustments associated with tissue conditioners and/or hard relines on the date of service are included in the fee for the tissue conditioner or reline and are not reimbursable.
Six months following the initial delivery of the prosthesis, the member may be eligible for hard reline if supported by documentation and medically (clinically) necessary. Additionally, please review whether the code planned for treatment requires prior approval.
Professional Dental Consultations
Provider letter 2024-29 Professional Dental Consultations is now available on the provider letters page of the OHCA website. The letter informs providers of appropriate billing practices and guidelines for a D9310. Providers who render D9310s are strongly encouraged to review the guidance to ensure all requirements have been met for billing purposes.
Dental Page on the Public Website
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.
Quitting tobacco is difficult, but it is one of the best things your patients can do for their health. Over 50% of adults who smoke try to quit every year but often take the “cold turkey” approach, leading many to relapse. Having a conversation with your patients about quitting smoking may take an extra bit of time, but it can be life-changing for them — your advice could be the push they need.
3 Ways to Start the Conversation
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Talk about their current health. If they have allergies, heart disease, breathing trouble or even mental health issues, talk about how quitting can help.
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Talk about their goals. Whether they’re trying to save money, spend time with family or simply feel better, quitting can help.
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Add it to their care plan. As you wrap up their appointment with medication instructions and home exercises, mention the Oklahoma Tobacco Helpline’s free resources.
Quit Services Available to All Oklahomans
The Oklahoma Tobacco Helpline offers free resources to those thinking about quitting tobacco, including:
- Patches, gum or lozenges to fight cravings fast.
- Coach support for 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.
Encourage your patients to find the free services that work for them. Find additional materials for your office for free, such as pens, brochures, badge reels and posters. Order your supplies at OKhelpline.com/order.
According to recent reports by the Centers for Disease Control and Prevention (CDC) and others, Benzodiazepines (BZDs) and opioids are a potentially deadly drug combination. Overdose deaths due to an opioid combined with a BZD are 10 times higher than those due to an opioid alone. BZDs are involved in nearly 17% of all overdose deaths, and over 90% of BZD-related deaths also involve opioids. Between 2019 and 2020, emergency department visits for BZDs overdoses rose by nearly 24%, with more than 34% of these cases also involving opioids.
In Oklahoma during 2022, there were more than 900 opioid-related overdose discharges (i.e., nonfatal drug overdose hospital discharges of all intents) and more than 400 BZD-related overdose discharges. To avoid this potentially deadly combination, health care providers must always carefully weigh the risk versus benefit of co-prescribing opioids and BZDs. Please implement these proven strategies to reduce the risk of overdose:
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Use Alternatives to Opioids and BZDs: Consider non-opioid pain management strategies and alternatives to BZDs for anxiety or sleep. Cognitive-behavioral therapy (CBT) is the preferred treatment modality for the treatment of insomnia, while multiple non-opioid treatment options are recommended for managing both acute and chronic pain.
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Gradually Taper to Reduce Medications: If both opioids and BZDs are temporarily necessary, consider implementing a gradual tapering plan to reduce the dosage over time, rather than abrupt cessation. Tapering gradually can help reduce withdrawal symptoms and lower the risk of serious complications.
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Close Monitoring and Communication: Regular follow-up appointments and open communication with patients can help identify signs of opioids and BZD misuse, over-sedation, or other side effects.
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Patient Education: It is essential to provide clear instructions on safer use of these medications and the risks associated with combining them. Educate patients on the dangers of combining opioids and BZDs, particularly the risk of respiratory depression and the potential for fatal overdose. Encourage patients to avoid alcohol and other medications that can cause respiratory depression while on these medications.
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Prescribe Naloxone: Currently, only 1 naloxone prescription is dispensed for every 70 high-dose prescriptions, and rural counties have the lowest naloxone dispensing rates. Naloxone is covered by SoonerCare and does not count toward the member’s monthly prescription limit.
For SoonerCare medication coverage-related questions, please contact the 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.
What is required in my SLP PA submission?
Depending on the period of the request (initial vs. subsequent/continuation), documentation requirements may change. Additionally, situations such as a transfer-back (returning to OHCA from SoonerSelect), change of provider (services to be delivered under a different provider ID), TEFRA (retroactive eligibility), or amendments involve their own specific requirements. Please feel free to print out and use the table below as a guide when submitting a PA request on the PA Portal. Next month’s newsletter will involve a table for PT/OT.
| Submission Type |
Documentation Requirements |
Limitations |
| SLP Evaluation Request |
1. HCA-61 form
2. Rx for services
3. Referring provider visit note
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2. Request cannot exceed a timeline of 90 days from the signed date on the Rx.
3. Referring provider visit note needs to be from within the past 12 months.
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| SLP Treatment Request |
1. HCA-61 form
2. SC-15 Parental Consent form or clinic’s own equivalent
3. Evaluation note completed within the past year
4. Progress note – if request is to continue services within the year of above evaluation
5. Rx for services
6. Any request for CPT 92526 cannot exceed six months in duration
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2. Request cannot exceed one year from parental consent.
3. Request cannot exceed one year from the date of the SLP evaluation.
4. Progress notes for reauthorization need to be recently completed, followed by a timely submission.
5. Request cannot exceed one year from the signed date on the Rx.
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| SLP Transfer-Back Request |
1. HCA-61 form
2. SC-15 Parental Consent form or clinic’s own equivalent
3. Evaluation note completed within the past year
4. Progress note – if request is to continue services within the year of above evaluation
5. Rx for services
6. SoonerSelect contracted entity approval letter
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1-6. All transfer-back PA requests will be approved upon meeting documentation requirements for a period of up to 90 days, or the original end date of the contract entity approval letter, whichever period is shorter. The end date will also be reduced based on the year timeline of the SLP evaluation, parental consent form and Rx for services.
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| SLP Change of Provider Request |
1. HCA-61 form
2. SC-15 Parental Consent form or clinic’s own equivalent
3. Evaluation note completed within the past year at the old clinic
4. Progress note – if a recent one exists but not necessary for approval
5. Rx for services
6. SC-16 Change of Provider form
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2. Request cannot exceed one year from parental consent.
3. The evaluation completed by the old clinic within the past year is always needed.
4. If a period of six months has passed since the evaluation by the old clinic, then the new clinic can perform and bill a new evaluation.
5. Request cannot exceed one year from Rx.
6. It is the new clinic's responsibility to ensure that the family has communicated the provider change with the old clinic. If not, please ensure that the old clinic knows that care will now continue at your location.
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| SLP TEFRA Request |
1. HCA-61 form
2. SC-15 Parental Consent form (if available)
3. Evaluation note completed within the past year
4. Rx for services
5. TEFRA award letter granting retroactive eligibility
6. A current progress note
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1. Need to reflect the historic start date and the future end date and account for the entirety of services.
2. Consent from does not need to be an OHCA-specific form.
3. The evaluation that was performed before the historic start date.
4. Rx needs to be signed/dated before the historic start date.
5. Submission should occur in a timely fashion once the family provides the clinic with a copy of this letter.
6. A current progress note is necessary if services are to not only be retroactive, but to also seek coverage for the future.
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| SLP Amendments
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1. HCA-60 Amendment form
2. A current progress note may be required on a case-by-case review basis if the request seeks additional coverage: extending timeline, adding units, adding line items or changing CPT codes.
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1. This form must indicate the change that is needed. Check boxes for all applicable changes being sought.
2. Requests for additional coverage must be submitted within the authorization timeline. A new PA request must be submitted after the authorization timeline.
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ABLE Tech's Device Reutilization Program is 100% donation- and return-based. Without community contribution, there wouldn't be a robust inventory. They are striving to break their own records in 2025, so if you or your patients have equipment that you're no longer using and would like to donate, visit the donation page.
If you would be interested in collaborating with ABLE Tech to host a donation drive at your organization, please email them at atreuse@okstate.edu
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