Health care providers in a variety of clinical settings can play a critical part in helping their patients quit using tobacco. SoonerCare reimburses providers who use the Five A’s approach with their patients for tobacco cessation counseling. If you're a provider or clinic interested in integrating tobacco cessation best practices into routine patient care, visit the SoonerQuit page for provider resources and microlearning modules.

OHCA will transition to processing some SoonerCare prior authorizations (PAs) through the new eQSuite Care Coordination Provider Portal. PAs for behavioral health, scheduled medical transportation, private-duty nursing and out-of-state requests can now be electronically submitted through the portal. To gain access to the eQSuite Care Coordination Provider Portal, call the OHCA Provider Helpline at 800-522-0114, option 3. Use of the portal will reduce turnaround times for authorization decisions and increase automation and consistency in PA submissions.

Are you a registered dietitian, registered nurse or pharmacist with experience and training in diabetes self-management? Are you associated with a Diabetes Self-Management Education and Support (DSMES) program accredited by the ADA or ADCES? If yes to both, you may be eligible to bill Medicaid for your services. SoonerCare needs you! Start by submitting a new contract and enrolling your group and you (the diabetes educator). Learn more on the provider diabetes page. 

The American College of Gastroenterology and the American Gastroenterological Association provide recommendations for the primary care treatment of gastroesophageal reflux disease (GERD). Follow the chart below for initial management and ongoing management.

SoonerCare has several treatment options on the 90-day maintenance drug list available without prior authorization (see “Anti-Ulcer”). For questions about SoonerCare pharmacy benefits, contact the pharmacy help desk at 405-522-6205, option 4, or 800-522-0114, option 4. For questions about SoonerSelect pharmacy benefits, contact the pharmacy help desk associated with your member’s health plan or email SoonerSelect@okhca.org.

Initial Management of GERD

• Proton pump inhibitor (PPI):
  • 30-60 minutes before a meal (i.e., not bedtime dosing)
  • 8 weeks of use
• Endoscopy if:
  • Weight loss
  • Gastrointestinal (GI) bleeding
  • Dysphagia
  • Risk factors for Barrett’s esophagus (BE)

Ongoing Management of GERD

• Weight loss if overweight/obese
• Avoid tobacco and “trigger” foods
• Use once daily PPI at the lowest effective dose
• Bedtime:
  • Avoid meals within 2-3 hours
  • Elevate head of the bed
• Indications for chronic PPI use:
  • Eosinophilic esophagitis
  • Esophageal ulcer
  • Peptic stricture
  • BE
  • Severe erosive esophagitis
  • Idiopathic pulmonary fibrosis
  • Patients at high risk for upper GI bleeding

Discontinue Treatment

• After 8 weeks, for all patients without indication for chronic use
• Abrupt DC or tapering can be considered
• Consider managing rebound hyperacidity for patients on long-term PPIs

Member Eligibility

To verify eligibility on the OHCA provider portal, look for SoonerDental. If it's not listed, the member remains on traditional SoonerCare, and you may continue as usual. If SoonerDental is returned in your results, verify eligibility with the member’s plan — DentaQuest or Liberty Dental Plan — via their provider portal. If unable to determine which plan the member is assigned to, ask the member for their ID card, and proceed with contacting their plan.  

If you have any questions or comments regarding service provisions, you can contact DentaQuest at 833-479-1007 or okproviders@dentaquest.com or Liberty Dental Plan at 888-902-0342 or okprinquiries@libertydentalplan.com. 

Please ensure your office staff checks member eligibility on the day the member is in your office before performing any services. Members are not responsible for services received during a period of ineligibility

Dental Retro PA Requests

OHCA will allow retro prior authorization requests to be submitted up to five business days after the first service date. Requests beyond the five days will be canceled.

SoonerSelect Services

The SoonerSelect dental contracted entities (CEs) are required to administer medically necessary, covered services in a manner that is no more restrictive than what is required by OHCA in the SoonerCare fee-for-service (FFS) program (see O.A.C. 317:55-3-10). CEs may request to implement alternative processes for administration of medically necessary covered services under the SoonerSelect dental program. Alternatives requested are subject to OHCA review and approval.

When should I start/from date my PA request when submitting a PA in the provider portal?

When submitting a PA request through the portal, you must enter a start/from date and an end date for your request. The start/from date entered on the PA must be a current or future date. Entering any historic date will automatically cancel your request, and it will not go to a reviewer for clinical review.

When should I end date my PA request?

Most therapy requests can extend up to a year if there are no limitations with the documents provided. The parental consent form or Rx for services provided is valid for 1 year from the date of the parent's or referring provider's signature, whichever is earlier. For example, if the parental consent form was signed on July 1, 2025, and the Rx for services was signed on June 13, 2025, then the PA request end date cannot be later than June 13, 2026.

If your office or patients have any gently used durable medical equipment (DME) that is no longer being used, return it or donate it to Oklahoma ABLE Tech's Device Reutilization Program. This program is 100% donation-based, and without community contributions, there is no robust inventory. Their greatest needs are blood pressure monitors, grab bars, lift chairs, shower chairs and wheelchairs.

ABLE Tech staff retrieves donated equipment; sanitizes and refurbishes devices; works with vendors to repair the equipment if needed; and reassigns DME devices to the best-matched Oklahoman. Any Oklahoman who needs medical equipment or devices, regardless of income, is eligible for the program. Priority will be given to SoonerCare members.

Complete the online Device Donation form to schedule a drop-off or pick-up.