SoonerCare offers a robust benefit to members who need help making better choices to fight disease, lose weight and improve their health as they age. Learn more about SoonerCare’s tobacco cessation, diabetes management and nutrition counseling benefits. The resources include medications, counseling and training that are all free to all SoonerCare members.  

To align with EDI and SoonerSelect standards, OHCA has added “9999” to the ZIP+4 field for all providers where the ZIP+4 was missing. No changes were made to provider files if a ZIP+4 code was already on file. If OHCA made changes to your file, please include “9999” on the ZIP code for the billing, rendering and/or ordering provider(s) as needed when submitting claims to OHCA or our SoonerSelect partners. ZIP+4 codes must be unique to each provider service location. If claims are rejected due to ZIP code issues or if you believe your location may have a duplicate “9999” value, please check your provider portal or the OHCA Provider Directory for your assigned ZIP+4. You may also contact Provider Enrollment to confirm the correct ZIP+4 on file or request an update.

OHCA has extended ITU contracts that were set to expire on Oct. 31, 2025, to Dec. 31, 2025.

For the following provider types, 75-day renewals started 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

For the following provider types, 75-day renewals started Aug. 17, and contracts expire Oct. 31, 2025.

• Inpatient psychiatric facilities

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.

More than 75% of SoonerCare members don’t know that diabetes education is a covered benefit. Here are four ways you can help spread the word.

1. Remind your SoonerCare patients:

• 10 hours of training are free for first-time Diabetes Self-Management Education and Support (DSMES) users.
• 2 hours of training of training are free each subsequent year. 

2. Watch SoonerQuit’s (DSMES) and Medical Nutrition Therapy webinar.

3. Become a DSMES provider:

• Meet qualifications.
• Complete the DSMES-specific enrollment process.
• Enroll your group in the DSMES program.
• Enroll each specific provider, connecting them to your DSMES program.
• If you don’t provide DSMES, refer them to a DSMES provider nearby. Search for “Diabetes Self Management” in the specialty dropdown menu on the provider search page.
• Questions? Contact provider enrollment at 800-522-0114, option 5, or ProviderEnrollment@okhca.org.

4. Optimize treatment and testing:

• SoonerCare covers continuous glucose monitors (CGMs) for qualifying members at the pharmacy point of sale. Some members may require a prior authorization.
• SoonerCare covers 90-day fills of many diabetes maintenance medications.
• SoonerCare does not currently cover diabetes medications for weight loss.

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 reflect a needed change to a PA on the HCA-60 amendment form?

An amendment can be submitted to any approved PA that needs to be changed. Criteria for amendment submissions are listed here for SLP and PT/OT. Amendments seeking to add additional coverage to an approved PA should be submitted within the active authorization period with appropriate documentation. They cannot be submitted retroactively.

The HCA-60 amendment form must reflect the absolute change on the PA. As an example, if a PA was originally approved for line-item A for CPT code 97530 for 48 units, and the provider wants to add 12 more units of coverage to this PA, then the HCA-60 amendment form must reflect a total of 60 units in this “unit change” amendment.

The HCA-60 amendment form can reflect more than one change if the documentation supports it. In the example above, the provider may also need to extend the end date on the PA to use the 12 more units. In that case, both “date change” and “unit change” must be marked on the HCA-60 amendment form, and the form must reflect the needed timeline and units for the PA in its entirety.

How does the transfer-of-coverage apply in a transfer-back situation?

Approvals for transfer-back PAs are tied to the specifics listed in the SoonerSelect contracted entity (CE) PA approval letter, so the coverage requested should consider what remains unused in this letter.

Transfer-back PAs are approved for up to a 90-day period or the original end date of the SoonerSelect CE PA approval letter, whichever is less when requirements are met.

If a transfer-back PA provides a SoonerSelect CE PA approval letter showing an approval for 48 units for CPT 97530, and 12 of these units were used by the clinic before transfer-back, then the PA should be submitted for a maximum of 36 units, accounting for what has already been claimed.

Oklahoma ABLE Tech's Device Exchange Program can connect individuals with other Oklahomans to exchange medical equipment. It's a person-to-person trade that works just like a free, classified online marketplace.

An individual can donate equipment for free, or they can sell it for a fair price. When Oklahomans need to find equipment, ABLE Tech will match them with someone who has it. Equipment includes items like wheelchairs, modified vehicles, lift chairs and other devices and supplies. View available items on the device exchange website (list changes daily).

Individuals can request an item by completing the online form or print form. Some devices may be listed by individuals. In that case, the individual seeking a device would contact the person directly using the information from the listing.