April 2025
The SoonerSelect 2025 open enrollment period runs from May 1-June 13. During this period, encourage your patients to visit the SoonerSelect page and review their health and dental plans. There’s a galaxy of extra benefits offered by each.
SoonerSelect members can change either their health plan, dental plan or both. If they’re happy with their current plans, they don’t need to do anything.
Members can change plans online at MySoonerCare.org or by calling the choice counseling line at 800-987-7767, option 5. Changes must be completed by June 13, 2025.
We encourage you to print out open enrollment posters for your office or clinic. Visit the OHCA publications page and you’ll find downloadable files available in English, Spanish and tailored for American Indian/Alaskan Native members.
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 will be extending all ITU contracts that are set to expire on March 31, 2025, to July 31, 2025.
For the following provider types, 75-day renewals start April 16, and contracts expire June 30, 2025.
- Outpatient behavioral health agency
- Partial hospitalization
- Day treatment
- CBSCC
- CCARC
- Paraprofessional
- Psychologist
- School-based paraprofessional
- Schools — ESPDT
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.
SMART, or Single Maintenance and Reliever Therapy, is the preferred treatment for many patients with asthma, and SoonerCare makes it easy to prescribe SMART! Both SMART agents budesonide/formoterol (Symbicort®-brand preferred) and mometasone furoate/formoterol (Dulera®) are available as Tier-1 medications, and they are part of SoonerCare’s 90-day supply maintenance drug List (see Chronic Obstructive Pulmonary Disease (COPD) Medications list). SMART medications may require prior authorization for some members. Current quantity limits support using these agents as both maintenance and reliever therapy.
For more information, visit the health plan websites and utilize the resources within the provider portals. If you have questions about asthma medication coverage, call the pharmacy help desk associated with your patient’s health plan.
May is National Stroke Awareness Month, a crucial time to highlight stroke prevention and management strategies. Stroke remains a leading cause of disability and death, but as a SoonerCare provider, you play a crucial role in reducing your patients’ risk by connecting them to covered benefits that support better health outcomes.
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: Guidance on following a heart and brain-healthy diet to reduce the risk of stroke. SoonerCare covers six hours of MNT per year.
What it is: Evidence-based education to help patients better manage their diabetes.
Benefits: Patients learn skills to maintain healthy blood sugar levels and prevent complications. SoonerCare covers 1 hour of individual training and 9 hours of group training in the first year, with 2 hours of follow-up education each year thereafter.
What it is: Free tobacco cessation counseling sessions with their 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, including 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
Early intervention saves lives! Encourage your patients to take advantage of their benefits to reduce their risk of stroke and improve long-term health outcomes.
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 at SoonerQuit Program SoonerCare Benefits Overview.
Does a progress note need to be tied to an actual encounter?
All prior authorization requests submitted for therapy service will require a recent evaluation or progress note. The note is the basis by which we determine the member’s current medical need for the skilled services.
For any continuation request within the year of an evaluation, a progress note is required to provide justification of medical necessity. Progress notes can show a continued need for treatment by ascertaining goal progress, confirming changes due to rendered services, recognizing changes due to gaps in services, and creating a cohesive record of the member to date. This note can also be useful for handoff purposes.
For PT/OT or SLP, when a progress note is required for a PA request, it should be tied to an encounter, and relevant measurements should be conducted during the encounter. Progress note visits should, at a minimum, include this requirement for PT/OT and SLP: Subjective and objective measures showing current progress toward established and relevant goals with a detailed commentary provided.
Below is an example:
Goal: Member will elicit ability to perform the single leg hop test for at least 75cm for the R. LE by 6 months without compensatory movement patterns suggesting good synergistic LE muscle activation for a safe return to age-appropriate activities and participation in high school basketball.
Current Progress: Continue, pt does not meet this goal as written.
The commentary above does not elaborate on goal progress or show a continued need for skilled intervention. However, the commentary provided below meets these requirements.
Current Progress: Continue, member demonstrated ability to perform SL hop safely at almost 6 months post-op today; member can perform 55 cm with mild upper body swaying present eliciting continued need to improve plyometric strength and synergistic LE stabilization when landing; Prognosis: excellent with continued coverage over the next auth period.
Should my therapy note have a title?
Any note being submitted in a prior authorization request should have the appropriate note title. This will help cue the clinical reviewer. The note should specify if it is an initial/annual evaluation, re-evaluation or progress note. Though treatment notes are not required to satisfy any prior authorization request, the necessary components of a progress note, as listed above, could be added to a treatment note. When this occurs, the note title should be changed to a progress note.
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