March 2025
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.
For the following provider types, 75-day renewals started Jan. 15, and contracts expire March 31, 2025.
- Hospital
- 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.
Hypertension is a leading cause of heart disease and stroke. Managing blood pressure is especially important for patients’ overall health. You play a key role in helping patients manage these conditions. SoonerCare offers Medical Nutrition Therapy (MNT), Diabetes Self-Management Education and Support (DSMES), and robust tobacco cessation benefits to support better health outcomes.
What it is: Personalized nutrition counseling with a licensed registered dietitian.
Benefits: Patients can learn how to adopt a heart-healthy diet with six hours of nutrition counseling a year.
What it is: Evidence-based education to help patients better manage their diabetes.
Benefits: Patients gain skills to control blood sugar, which also supports blood pressure management. SoonerCare covers one hour of individual training and nine hours of group training in the first year, with two hours of follow-up education each year thereafter.
What it is: Free tobacco cessation counseling sessions with a SoonerCare provider to develop personalized quit plans, including nicotine replacement therapy (NRT) and medication options.
Benefits: Patients receive comprehensive tobacco cessation, including:
- Eight covered tobacco cessation counseling sessions with a SoonerCare provider.
- Full coverage of all seven FDA-approved cessation NRT and medications: nicotine gum, nicotine lozenges, nicotine patches, nicotine inhalers, nicotine nasal spray, bupropion (Zyban) and varenicline (Chantix).
- NRT and cessation medications do not count against your patient’s monthly six-medication limit!
Oklahoma Tobacco Helpline support includes certified quit coaches, an interactive dashboard and additional quit resources.
How you can help:
- Screen patients for tobacco use and high blood pressure at every visit.
- Use the 5A’s approach to guide quit conversations.
- Refer your patients to the Oklahoma Tobacco Helpline via fax, web or EHR for additional quit support.
Encourage Your Patients to Take Action
For more information, including technical assistance in implementing these benefits into your practice, patient eligibility and referral processes, contact SoonerQuit@okhca.org and visit our microlearn for more information at SoonerQuit Program SoonerCare Benefits Overview.
Claim Inquiries
Please direct claim inquiries to the Oklahoma Health Care Authority at 800-522-0114, option 1.
Dental Authorization Unit Voicemail
When leaving a message for the dental authorization unit staff, please include your callback number, the prior authorization number and/or member ID.
Dental Benefit Plans
OHCA is available for information regarding the dental benefit plans at 800-522-0114, option 6.
Medicaid Compliance for the Dental Professional
Please visit the CMS page on Medicaid Compliance to access resources about documentation expectations, how to use dental software as a tool for good documentation practices, and other recommendations for dental practices.
Prior Authorization Amendment Requests
All amendment requests must be made via the provider portal and be accompanied by form DEN-7. This would include requesting orthodontic banding updates.
Member Eligibility
A prior authorization is not a guarantee of payment. Please ensure the member has current eligibility before rendering service. The member cannot be billed for any services rendered during a period of ineligibility.
You have the power to inspire change in your patients. As they look ahead to warmer weather, longer days and fresh blooms, they may be ready to make positive changes for their health, too. This season is the perfect opportunity to have meaningful conversations about quitting tobacco.
Starting the Conversation
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Connect quitting to their current health. As spring allergies and respiratory concerns increase, discuss how quitting tobacco can improve these symptoms.
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Focus on their personal goals. Whether your patients want to be more active outdoors, save money or spend quality time with family, help them see how quitting tobacco supports these goals.
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Discuss preventative care. Did you know that within 10 years of quitting tobacco, your patients' risk of lung cancer can drop by half? March is Cancer Prevention and Early Detection Month. When talking with your patients who use tobacco or have a history oftobacco use, consider discussing cancer screenings and preventative care.
The Oklahoma Tobacco Helpline offers comprehensive free resources for your patients:
- Personalized coaching calls.
- Nicotine replacement therapy (patches, gum or lozenges).
- Text message support with tips and advice.
- Online group sessions for peer support.
Remember: Your patients trust you. Your guidance and support may be the push they need to quit tobacco and turn their health around.
Resources for Your Practice
Make your office a supportive environment for tobacco cessation. Order free materials including:
- Educational brochures
- Quit-support resources
- Office supplies with helpline information
- Informational posters
Visit TSET.OK.gov/orders to stock your office.
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 Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy webinar by SoonerQuit. Together, we can improve health outcomes and enhance diabetes literacy.
If you're seeking to provide 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.
How should I submit a transfer-back PA request when the provider portal will not let me submit it?
Most SoonerCare/OHCA members transitioned to SoonerSelect when it took effect in April 2024. However, any changes in a member’s profile can lead to a brief transfer-back period with OHCA. Additionally, there can be a brief transfer-back period with OHCA when members are transferring from one SoonerSelect contracted entity (CE) to another (e.g., Oklahoma Complete Health to Aetna). These changes often occur during the first week of the month. In light of this, we recommend that all clinics continually verify eligibility for members prior to a date of service.
If a member had an approved authorization with a SoonerSelect CE and was transferred back to OHCA, the service rendering clinic is responsible for submitting a timely transfer-back PA request with OHCA. The requirements for all types of PA requests, per profession, are included in the therapy FAQ sections of our January 2025 and February 2025 newsletters.
As transfer-back periods tend to be brief (usually a month), a transfer-back PA request must be submitted within this timeframe upon eligibility verification. Once the member is returned to a SoonerSelect CE, a PA submission on the provider portal will not be possible due to a system update in the provider portal system.
Routine eligibility verification is still being adopted into workflow for those clinics serving the Oklahoma Medicaid population. Accordingly, as a temporary solution, a transfer-back PA request can still be granted for those clinics that cannot submit their request in the provider portal.
To obtain a transfer-back PA approval in such cases, please email TherapyAdmin@okhca.org with all transfer-back PA requirements attached (a single PDF is preferred). Additionally, include the following information in the email body:
- OHCA provider ID number with location alphabet
- OHCA member RID number
- Timeline for coverage (limit within transfer-back period)
- Primary diagnosis
- Each line-item CPT code and associated units
If the attached information meets the transfer-back PA requirements, a PA number will be emailed back to you.
What should I do if I cannot submit a TEFRA retroactive authorization request in the provider portal since the member has already transitioned to a SoonerSelect CE?
We encourage TEFRA PA requests to be submitted promptly upon receipt of the TEFRA award letter. If the member has already transitioned to SoonerSelect and their TEFRA retroactive authorization request cannot be submitted in the provider portal, please send an email to TherapyAdmin@okhca.org with all TEFRA PA requirements attached (a single PDF is preferred). Additionally, include the following information in the email body:
- OHCA provider ID number with location alphabet
- OHCA member RID number
- Timeline for coverage (limit within transfer-back period)
- Primary diagnosis
- Each line-item CPT code and associated units
If the attached information meets the TEFRA PA requirements, you will be emailed a PA number.
Oklahoma ABLE Tech has 67 blood glucose monitors available and ready for new homes. Brands include One Touch, Free Style and Contour. Please note, test strips are expired, and a prescription is required with your application.
If one of your patients is interested, they should complete an online application. Or they can print an application and fill it out by hand. The mailing address and email address are on the application.
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