November is a month to bring awareness and education about diabetes. Diabetes affects 38 million Americans and around 390,000 Oklahomans. SoonerCare offers a benefit for diabetes self-management that provides qualifying members with education and tools to help them make lifestyle changes, manage and control blood sugar and blood pressure levels, improve medication adherence, and connect them with additional resources. 

There are currently four FDA-approved products for the prevention of lower respiratory tract disease (LRTD) due to respiratory syncytial virus (RSV). Arexvy and Abrysvo are approved for individuals ages 60 and older. Abrysvo is also approved for pregnant individuals at 32 weeks through 36 weeks gestational age to prevent LRTD caused by RSV in infants from birth through 6 months of age.

Beyfortus (nirsevimab-alip) and Enflonsia (clesrovimab-cfor) are approved for prevention of LRTD due to RSV in neonates and infants. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend one dose of nirsevimab or clesrovimab for all infants younger than 8 months of age who are born during or entering their first RSV season. They also recommend nirsevimab be given to children ages 8-19 months who are at increased risk of severe RSV disease and are entering their second RSV season. Nirsevimab and clesrovimab do not require prior authorization; however, SoonerCare members must receive them through the VFC program. SoonerCare does not currently cover Synagis (palivizumab) as positivity rates are currently below 10%. Additionally, Synagis will be discontinued by the manufacturer on Dec. 31, 2025.

If you have questions about a particular medication or other pharmacy benefit questions, please call the Pharmacy Help Desk associated with your patient’s health plan.

Please update your 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 (ATN), received upon submitting your update on the OHCA provider portal, to ProviderEnrollment@okhca.org with "SoonerSelect update" and your ATN in the subject line.

For the following provider types, 75-day renewals started Aug. 17, and contracts expire Nov. 30, 2025.

• Inpatient psychiatric facilities

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

• Certified nurse practitioner (ARNP)
• Certified nurse midwife
• Certified registered nurse anesthetist
• Clinical nurse specialist
• Chiropractor
• Diagnostic sleep study
• Group
• Mobile and/or portable dental clinic
• OSU and OU physicians
• Rural health clinic

Please ensure that the contact information, including email address, is up to date for all individual and facility/group provider files so you don’t miss important contract information.

The 21st Century Cures Act requires all states to implement an electronic visit verification (EVV) system for Medicaid-funded personal care services and home health care services. EVV is a technology-based system that uses phone and computer platforms to capture and verify details such as the type of service; rendering provider; and location, date, and start/end times of service.

These requirements apply to all Medicaid-enrolled providers submitting claims for applicable personal care services, regardless of whether services are authorized under the Medicaid State Plan, SoonerSelect, Money Follows the Person (Living Choice) or the 1915(c) home and community-based services waivers.

Providers contracted with SoonerCare and delivering services under the HCBS waiver programs, state plan personal care or Living Choice should begin onboarding with the state’s designated EVV platform, FiServ.

Providers contracted with one of the SoonerSelect plans should begin onboarding with the EVV platform selected by the contracted entities, HHAeXchange. New users must first complete the Xchange self-registration form. If you are already registered, you can sign up for live training or take one of the on-demand training curriculums. 

Stay tuned to OHCA's EVV page as additional guidance, training materials and technical support will be made available to assist providers in meeting EVV compliance requirements. Please let us know if you have any additional questions or concerns.

Dental benefits are available for adult SoonerCare members served through the In-Home Supports Waiver or Community Waiver. Adults with developmental disabilities served under these waivers are evaluated by their case managers for initial services, such as a general exam, cleaning and X-rays. Requests for additional treatment should be directed to the case manager.

All services must be prior authorized by the member’s case manager. The Developmental Disabilities Services division of Oklahoma Human Services has prepared information packets about the benefits to distribute to interested dental providers. Packets are available from Julie Whitworth at the OHS state office at 405-521-2237.

Inquiries and Updates

• For all dental claim inquiries, call 800-522-0114.
• To see the latest updates, visit OHCA's global messages page. There is also a sign-up on the page for web alerts.

Early childhood caries is the most common chronic childhood condition, yet it is largely preventable. Cavities and tooth decay in early childhood are five times more common than asthma and seven times more common than hay fever. Fluoride varnish reduces dental decay by one-third when used at least twice a year. Learn more about fluoride varnish for SoonerCare members.

Lung cancer is the #1 cause of cancer deaths among U.S. adults. In Oklahoma, only 9% of high-risk individuals are screened for lung cancer. Early detection is crucial for successful treatment. If a patient is 50 or older, currently smokes or has quit within the past 15 years, they may qualify for a lung cancer screening. SoonerCare covers a low-dose lung cancer screening benefit for qualifying members.

Can a re-evaluation CPT code be requested in a PA submission?

Re-evaluation requests are approved by OHCA when submitted documentation supports an additional evaluative service because of a member’s change in status or condition. The re-evaluation CPT codes (97164/97168) can be approved for PT/OT. Providers must submit a current progress note that describes the member’s current status and justifies additional evaluative services. Furthermore, a re-evaluation can be requested at least six months from the previously performed evaluation. Routine assessment of a member’s progress in accordance with the established plan of care (progress notes) is an expected component of ongoing care. It should not be coded as a re-evaluation.

When should a subsequent/continuation PA request be submitted?

A PA request should always be submitted with a present or near-future start date. It is important to note the end date of a previously submitted PA. Services may be rendered on both the start and end dates of approved PAs.

A new PA should not overlap with a previously approved PA. For example, if a PA is approved from Dec. 1, 2025, to Jan. 15, 2026, a subsequent PA cannot have a start date before Jan. 16, 2026.

Clinics should be aware of existing authorization timelines and timely submit a subsequent/continuation PA request to resume services as soon as possible following the end of a previously approved PA, if continued services are medically necessary.