Beginning July 1, there is now a single process to submit applications and credentialing documents for all SoonerSelect health plans through the Availity portal. Providers will only need to submit credentialing once through the portal. This single submission will be sufficient to cover all three health plans.

Credentialing status may be viewed via Availity. This will allow for a seamless process for business offices and will enable the health plans to leverage information already provided to support credentialing.

Please update your Oklahoma Health Care Authority 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 July 31, 2025, to Oct. 31, 2025.

For the following provider types, 75-day renewals start July 17, and contracts expire Sept. 30, 2025.

• Dentist
• Genetic counselor
• Independent diagnostic testing facility
• Independent lab
• Lactation consultant
• Maternal and infant health LCSW
• Room and board

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.

SoonerCare hospice benefits have expanded. A new law (House Bill 3980) now allows more members to receive hospice care if they qualify. Before, hospice services were limited to children, expansion adults and members with both Medicare and Medicaid (dual eligibles). Now, coverage is available to all SoonerCare members who meet hospice criteria and fall within eligible coverage groups. The same care guidelines and payment rules will apply to the newly eligible groups.

According to the U.S. Food and Drug Administration, smokers are 30 to 40% more likely to develop type 2 diabetes than non-smokers. SoonerCare offers two benefits to assist members with these challenges: tobacco cessation medications and diabetes self-management services. Learn more and refer your patients today.

SoonerCare covers dozens of prenatal vitamins at no cost to female members ages 10 to 50, and prenatal vitamins don't count toward monthly prescription limits. Many prenatal vitamins are available without prior authorization. SoonerCare also covers additional services for pregnant members in certain circumstances. While not listed on the 90-day maintenance drug list, several prenatal vitamin formulations are available for a 90-day supply without prior authorization.

For questions about SoonerCare pharmacy benefits, contact the SoonerCare Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 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.

What modifier and assignment code should my PA submission include?

A primary modifier must be present in any therapy PA submission. Each line-item in a PA request for a particular CPT code should be tied to a modifier that indicates the profession of service to ensure sufficient claims processing and reimbursement. This is also true for PA “assignment codes” which designate the profession: 14 for PT, 13 for OT and 09 for SLP.

1. SLP PAs: Requests should be submitted under the 09 assignment code, and all line-items should include the GN modifier. For example, line A for 92609 should have the GN modifier and line B for 92507 should also have the GN modifier.
2. PT PAs: Requests should be submitted under the 14 assignment code, and all line-items should include the GP modifier. For example, line A for 97530 should have the GP modifier, line B for 97110 should have the GP modifier, etc.

1. OT PAs: Requests should be submitted under the 13 assignment code, and all line-items should include the GO modifier. For example, line A for 97530 should have the GO modifier, line B for 97533 should have the GO modifier, etc.

The GT modifier indicates that services were rendered via telehealth. It should never be included in a PA submission; however, it should be listed as a secondary modifier when filing claims. For example, if weather conditions led to an SLP treatment session being delivered online, then the claims submitted for this session using line A for 92507 should include the primary GN modifier and add a secondary GT modifier.

How should I use modifier 59 with SLP services?

Modifier 59 is used to indicate that a procedure or service was independent from another procedure or service performed on the same day by the same provider. For the current OHCA-approved list of SLP CPT codes, this pertains to the use of CPT 92609 and 92507 on the same day by the same provider. If the speech-language pathologist of record plans to provide both types of treatments throughout the POC, then the PA submission should have CPT 92609 listed as line A with modifier GN, and CPT 92507 as line B with modifier GN. No other modifiers should be present on the PA submission.

When submitting claims for a given date of service, if both CPT codes are used, then a secondary modifier 59 needs to be added to line B for CPT 92507 along with the primary modifier GN. If only one of the two CPT codes is used on a given date of service, then the claim should be submitted with only the primary modifier GN. Applying this will ensure proper reimbursement when distinct services are performed on the same day. Review this ASHA article for more. 

What should a prescription for services being submitted on a PA request entail?

All PT/OT and SLP services requiring prior authorization must submit a prescription for the requested specialty. The submitted prescription should, at a minimum, include:

1. Member’s name and date of birth.
2. Referring provider’s name, credentials, signature and date of signature.
3. List the profession(s) toward which the prescription is directed.
4. Establish parameters if necessary (e.g., 2 times a week for 8 weeks).
5. List all applicable diagnoses for the skilled service(s) requested.

For all therapies, evaluations should be conducted within 90 days of the signed date on the prescription for services. Treatment requests are valid for up to 1 year from the signed date on the prescription unless parameters are established.

Any subsequent authorization request for PT and OT submitted within the year of an evaluation can derive the referring provider’s signature on the required progress note or re-evaluation being submitted in lieu of a prescription.

What are some recommendations to complete an SLP SGD/AAC evaluation?

Depending on a member’s level of speech/sound production and language comprehension, an SGD/AAC evaluation may be warranted to best meet the member’s needs. Review the guidelines for this evaluation PA request.

1. Note that CPT 92507 or 92609 are not the recommended codes to satisfy aspects of the SGD/AAC evaluation, including the trialing phase.
2. An SLP’s SGD/AAC evaluation will ultimately recommend a device that would be best suited to meet the member’s needs. Per the guideline, at least three devices should be trialed before coming to a conclusive recommendation, and three models of the same device do not meet this requirement.
3. As this process can be lengthy, it is equally important to note that no more than 4 units of CPT 92608 could be used per day added on to an SGD/AAC evaluation.
4. An SGD/AAC evaluation should be completed within 90 days of the signed prescription for this service.

The completed SGD/AAC evaluation should be provided to an OHCA-contracted SGD DME provider so that a timely DME PA request that meets requirements can be submitted.

Are you looking for ways to get out of the house and be a little more active this season? Oklahoma ABLE Tech currently has several specialized pediatric strollers in the Device Reutilization Program inventory. The weight capacity of these strollers ranges from 50 to 90 pounds, and they are suitable for children with various abilities.

Pediatric strollers can help families in many ways:

• Increase accessibility for outdoor activities
• Allow families to be active for longer periods of time
• Secure seats that provide postural support
• Encourage participation in daily life and other activities

ABLE Tech staff retrieves donated equipment, sanitizes and refurbishes devices, and reassigns durable medical equipment (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. For more information or to apply, visit ABLE Tech's Device Reutilization Program page.