May 2026
Reminder that the provider attestation requirement related to amended Executive Order 2025-16, is due by May 15, 2026. To complete your attestation:
- Log in to the Provider Portal.
- If the attestation is not attached to your file, you will see a "missing application section" alert pop up with a link to the attestation page.
- Click the link and select either the "Confirm" or "Not in Compliance" option.
- Select Update or Update and Finish to submit your response. You will see a pop up asking you to confirm submission.
View FAQs for additional info and submission instructions, or contact ProviderEnrollment@okhca.org or 800-522-0114, option 5, with questions.
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The SoonerSelect 2026 open enrollment period runs through June 12. Encourage your patients to visit the SoonerSelect page to review the plans and the extra benefits they offer. Members can change their health plan, dental plan or both. If they’re happy with their current plans, they don’t need to do anything.
If you would like free SoonerSelect open enrollment posters for your clinic or office, you can order them here (scroll down to the bottom of the page). Posters are available in English and Spanish.
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As the State of Oklahoma continues its transition to the new electronic visit verification (EVV) system, we are asking providers to take 8-10 minutes and share their perspectives in our EVV Transition Organizational Readiness Survey. Your feedback will guide us in supporting providers through the transition, and will help us in developing communications, training and resources. We recognize that organizations may be at different stages of readiness, and we appreciate your input as part of this process.
We are also continuing our EVV townhalls and you're invited to join us for the next event that's been rescheduled from May to the new time and date of 2 p.m., Tuesday, June 23. Register for the town hall. If you had already registered for the May town hall, you do not need to register again. However, new registrations are still being accepted. Agenda for the town hall:
- Compliance overview
- HHAX onboarding and communication timeline
- Considerations for utilizing third-party EVV vendors
- Claims management and billing workflow demonstration by DCI
- Provider readiness actions
- Live Q&A with Acumen EVV vendors and state staff
Town hall participation is strongly encouraged and questions can be directed to EVV@okhca.org. As planning evolves, additional communications will be shared to keep everyone informed of transition activities, training opportunities, and available support resources. Provider agency leadership, case managers and EVV oversight staff are encouraged to review these updates to support preparedness and coordination.
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Provider Files
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.
Provider Renewals
For the following provider types, 75-day renewals started March 15, and contracts expire May 31, 2026:
- Behavioral health practitioner under supervision
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Smoking can quadruple your patient’s risk of stroke, compared to non-smokers. Quitting can change that! SoonerCare offers free tobacco cessation counseling. Patients can also take advantage of free cessation medications, including all six FDA-approved products. Talk to your patients about the cessation benefit. Patients can receive extra help with the Oklahoma Tobacco Helpline, too.
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Recent reports from the U.S. Centers for Disease Control and Prevention (CDC) highlight the need to reduce co-prescribing of opioids and benzodiazepines (BZDs). Oklahoma data reinforces this concern. In 2024, of the more than 6,800 non-fatal emergency department discharges in Oklahoma, more than 1 in 4 involved opioids and approximately 1 in 28 involved BZDs.
Health care providers must carefully weigh the risks versus the benefits before prescribing these medications together. These evidence-based strategies can help reduce the risk of overdose:
- Avoid initiating co-prescribing.
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Limit the dose and duration if new co-prescribing is necessary.
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Consider alternatives, such as nonopioid pain management and non-BZD treatment of anxiety or sleep disorders.
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Increase monitoring for patients with long-term co-prescribing.
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Gradually discontinue (i.e., taper) long-standing co-prescribed medications. Educate patients on withdrawal symptoms.
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Educate patients about the risk of respiratory depression and fatal overdose. Remind them to avoid alcohol and other sedating medications.
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Prescribe naloxone or Opvee® (nalmefene). Both are covered by SoonerCare, do not count toward the member's monthly prescription limit, and have no copay.
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Follow current prescribing guidelines from the Oklahoma State Department of Health and the CDC.
If you have questions about pharmacy benefits, please call the Pharmacy Help Desk associated with your patient’s health plan.
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Oklahoma ABLE Tech helps Oklahomans get the durable medical equipment they need. The Device Reutilization team retrieves donated equipment, sanitizes and refurbishes it, and then matches each device with the Oklahoman who can benefit from it most. Any Oklahoman in need of medical equipment is eligible, regardless of income. Priority is given to SoonerCare members.
To maintain the highest operational procedures, there are some items that ABLE Tech is unable to accept:
- Foods, liquids and perishable items
- Medications
- Loose or opened bandages, gauze or medical supplies
- Oxygen-related supplies (concentrators, cylinders, tubing, etc.)
- Sharp items (needles, razor blades or prefilled syringes)
- Damaged, unsafe or unclean equipment (includes equipment that has duct tape, mold, smoke exposure, rust or urine damage)
To learn more about equipment donations or to schedule a donation drop-off or pickup, visit the Oklahoma ABLE Tech website. If a patient needs equipment, have them visit the Device Reutilization Program page and follow the instructions to receive equipment.
How long after completion of the profession-specific evaluation or progress note visit should a PA request for the therapies be submitted?
For PT/OT, the evaluation or progress note should be submitted for PA review within 30 days of the visit, with all requirements met. Though SLP does not have a set requirement on how long after completion of an evaluation or progress note, a PA request should be submitted, the 30-day timeline can be utilized to elicit a documented current need for services.
The service rendering clinic is responsible for timely submission of documentation for PA review and derivation of PA approval to ensure uninterrupted coverage for PA-requiring services. OHCA will make determinations on all submissions within 72 hours.
Though numerous situations could delay the actual start date for services for a member (scheduling conflicts, other appointments, holidays, etc.), a PA should still be submitted in a timely manner to ensure a covered timeline for whenever services begin.
Do I need to add modifier 52 for my SLP evaluation request?
For all PA submissions, regardless of profession, there must be a primary modifier included. For certain SLP evaluation PA requests, a secondary modifier 52 may be necessary if any of the situations below apply:
- Child is truly non-verbal or can say only a few words (age or diagnosis related).
- Formal assessments cannot be entirely performed or completed.
- Time constraints limit a comprehensive evaluation.
- Patient participation limits the evaluation.
- An informal detailed articulation summary (separate from the parent report) cannot be provided.
- Example of when an informal assessment of articulation is included:
A standardized articulation test was not administered due to the member’s limited verbal output and difficulty naming nouns. A sound inventory was taken during the evaluation and is as follows: /a/, /e/, /i/, /o/, /u/, /k/, /b/, /p/, /m/. Using the listed phonemes and vowels, member is able to produce CV/VC/CVC/VCV, CVCV combinations including the words: “car,” “peppa,” “mama” and “papa.” Phonological processes of fronting and final consonant deletion noted. Clinician judges member’s speech intelligibility to be 50%. Member is still mixing jargon with true words and currently presents with a moderate articulation delay.
- Second example:
Member is currently non‐speaking and relies on an AAC device for communication; therefore, formal assessment of articulation was not possible. He was observed engaging in vocal stereotypy, producing unintentional vocalizations that include “mama,” “dada” and isolated sounds such as /b/ and /w/. These vocal behaviors appear self‐stimulatory and are not used communicatively at this time.
Before the patient is evaluated: If it is known that any of the above scenarios will apply based on the doctor’s visit note or communicating with the family during scheduling, then modifier 52 should be added on the HCA-61 form as a secondary modifier prior to an evaluation PA request submission for either CPT code 97522 or 97523.
After the patient is evaluated: If the evaluation performed was not comprehensive and a detailed articulation summary could not be included, then the evaluation PA for CPT 97522 or 97523 will be adjusted to include modifier 52 as a secondary modifier reflecting a reduced evaluation.
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 therapies CPT codes, this pertains to the use of CPT 92609 and 92507 on the same day by the same provider. If the SLP of record plans to provide both types of treatment 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 information.
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Chief Executive Officer
Clay Bullard
OHCA Board of Directors
Marc Nuttle, Chairman
Norman, OK
Alex Yaffe, Vice Chairman
Oklahoma City, OK
Tanya Case
Duncan, OK
John Christ
Oklahoma City, OK
Kevin Corbett
Edmond, OK
Jeffrey Cruzan, M.D.
Oklahoma City, OK
Clark Jolley
Edmond, OK
Kim Leland
Norman, OK
Phillip Kennedy
Lawton, OK
Information contained within this newsletter is subject to change. Be sure to check OHCA provider letters, global messages and web alerts at OKHCA.org for the most up-to-date information.
Our vision is for Oklahomans to be healthy and to have access to quality health care services regardless of their ability to pay.
OHCA Core Principles:
Passion for Our Purpose
Empowerment and Accountability
Trust and Transparency
Solution-oriented
Servant Leadership
The Oklahoma Health Care Authority does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.
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