If you have any questions, please call the OHCA provider helpline at 800-522-0114. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Change of Provider. Amendment #5 See below for example of a planned service line for a Member needing adult size pullups (80 per month) under their SoonerCare benefit: CMs will change the SPA Review status on the line with the ZS modifier and provider listing of "Other" to "Request Withdraw" so the item will not calculate in the total plan cost. Soonercare Change of Provider Request Form. how to enroll. Toll free: (800) 522-0114. The information contained within this presentation is intended as a reference only and is current as of September 2019. Oklahoma Health Care Authority Website. Your site key token displays. ... Option 1 For Internet/EVS PIN resets or assistance with SoonerCare Secure Site. Required: Starting Location: Enter a street address or city or zip code from where you will start your drive to the provider by choosing one of the corresponding Google generates locations.The travel distance to each provider will be provided. Note: If you have not created your personalized site key token, you will be asked to do so before you sign into the SoonerCare Portal. This website is not compatible with Internet Explorer. The OKDHSLive! Q What documentation is needed when submitted a new prior authorization request for therapy? Hey SoonerCare members! Are you sure you want to logout? SoonerCare physician rates have not exceeded 90% since mid-2014 when state budget reductions resulted in a 7.75% reduction to rates, dropping them to 89.25% of Medicare. Provider Services(800) 522-0114 (405) 522-6205, Specialty Provider Services(405) 522-7301. Recommended Audience:Billing staff who submit 1500 professional claims. Dr. Garth Splinter, OHCA deputy CEO, briefed the … Adults (or members over age 14) may choose general practice, family practice, or internal medicine providers. This change also affects the provider network accessible to those who will be covered by SoonerCare … You may also use this web site to renew your eligibility for SNAP, SoonerCare or Child Care: or to request (apply for) these benefits. First-time applicants can use the online application to complete an enrollment application and sign a provider contract. How To: Change or Update Your SoonerCare Provider - YouTube Medicaid pays for services only after a liable third party has met its legal obligation to pay. If you are a Soonercare patient transferring services, please complete this form. Always log off and close all of your browser windows, https://okhca.zoom.us/webinar/register/WN_fa2ceKanS46pyQpPwMyBTQ, https://okhca.zoom.us/webinar/register/WN_Hnu8ypiVTVep36Eclb8_zw. If you recognize your site key token, you know you can safely type your password. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. Reach Out Now. Oklahoma Health Care Authority (OHCA) announced changes to a SoonerCare member policy regarding out-of-state services which will go into effect Sept. 1. The Oklahoma Health Care Authority (OCHA) may also change a member’s enrollment from one Primary Care Provider to another under certain circumstances, such as: They can also: Complete a saved application; Obtain submitted application status; Update current information; Things you should know: 3. provider agrees that all services rendered by provider to soonercare members shall be billed by the soonercare-contracted outpatient behavioral health agency (ies) indicated in provider’s provider information and that provider shall not bill any services individually. OHCA Call Tree Options. When providers are performing medically necessary polymerase chain reaction (PCR), laboratory testing for combinations of COVID-19 and Influenza A&B, or combinations of COVID-19, Influenza A&B and RSV, these are the appropriate codes to bill. The Oklahoma Health Care Authority (OHCA) is currently accepting proposals from corporations, in an effort to privatize Medicaid and outsource the services that OHCA has successfully provided for decades. This site gives you the opportunity to maintain provider information, access claim and prior authorization related functions, and receive messages from the OHCA that apply specifically to you. Remaining language continues to describe the HAN as organized for improving access, quality, and continuity of care for SoonerCare members, and offering care management and coordination to persons with complex health care needs. General coding for services will not be addressed in this presentation. Monoclonal antibody infusion is reimbursable when provided in a hospital outpatient department or physician's office experienced in infusion services. SoonerCare provider and prescriber numbers. According to OHCA, the change to the out-of-state (OOS) services policies could impact SoonerCare members who seek speciality medical care outside of Oklahoma on a regular basis. https://okhca.zoom.us/webinar/register/WN_Hnu8ypiVTVep36Eclb8_zw. This number is available for the initial fill on a prescription only if the valid prescriber NPI number is … OHCA is presenting a webinar titled "UB-04 Claim Submission" on Tuesday, Jan. 26 at 10 a.m. If you live in Oklahoma and have a valid SoonerCare ID number, you qualify for SoonerRide, the state's Medicaid transportation service. Payment Rates (405) 522-7083. • Complete the form below. NPI numbers should not be used for claims submission until May 23, 2008. web site is an easy way to see if you might be eligible for Food Benefits or SoonerCare Medicaid. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). This site gives you the opportunity to maintain provider information, access claim and prior authorization related functions, and receive messages from the OHCA that apply specifically to you. Medicaid is the payer of last resort in most circumstances. SoonerCare Provider Reimbursement: OHCA FIN 2006-05 The split eligible payment constitutes payment in full for all services rendered on those days on which the patient was eligible for Medicaid and must be accepted as such by the provider hospital. • Referrals must contain the individual provider’s SoonerCare legacy number. SoonerCare prior authorization process to change Posted on: 10/18/17 The Oklahoma Health Care Authority (OHCA) is in the middle of major changes to the SoonerCare (Medicaid) prior authorization process. They are just meant to keep you up-to-date on your out-of-pocket expenses. SoonerCare Choice is Oklahoma’s statewide managed care model in which each member is linked to a primary care provider who serves as their 'medical home'.PCPs manage the basic health care needs, including after hours care and specialty referral of the members on their panel. Recommended Audience:Billing staff who submit UB-04 Institutional claims. Register to attend the 1500 Claim Submission webinar on Jan. 14 at 2 p.m. at the link below. Attendees will learn more about the policy and procedures of submitting Medicaid primary, Medicaid secondary, HMO co-pay and Medicare crossover claims. The Oklahoma Health Care Authority's secure portal is intended for providers, clerks and billing agents. Managed care has already failed in Oklahoma, with no evidence to suggest the market has changed since the last attempt. OHCA Provider Services - Oklahoma Health Care Authority. What can you do in the Soonercare Provider Portal. the previous provider, if applicable, of their desire to change providers. SoonerRide is designed for people without adequate transportation to medically necessary appointments. It would not be appropriate to bill for both these services on the same date of service, unbundle these tests and bill each test separately, or to bill either of these codes and additionally bill any component separately. The term “contracted” is defined as a provider that was • Submitting prior authorizations on the portal to include modifiers (AS, 51, 82, … Oklahoma’s Medicaid Agency. Maternal and Infant Health Social Work Services, OHCA Cesarean Section Quality Initiative Archives, Federally Qualified Health Centers/Rural Health Clinics, 2017 18 OHCA Tribal Partnership Action Plan, OHCA - 2016 Tribal Partnership Action Plan, Indian Health Unit Frequently Asked Questions, Quality Improvement Initiative Through Practice Facilitation, Steps to follow to have a claim reviewed or reconsidered, Medications Requiring Prior Authorization, Recommended Childhood and Adolescent Immunization Schedule. Tele/Text: 405. Below are examples of different letters you may receive. OTPs will be able to bill for MAT medications, including methadone, and treatment services that are currently SoonerCare compensable (e.g., therapy) in accordance with the SoonerCare fee schedule for Providers who are already enrolled in the SoonerCare Provider program can renew their contract online. OHCA will now send letters each month to inform those members who have cost sharing or copays of their status. Attendees will learn more about the policy and procedures of submitting Medicaid primary, Medicaid secondary, HMO co-pay and Medicare crossover claims. Signed By _____Nursing Facility Attendant . OHCA is presenting a webinar titled "1500 Claim Submission" on Thursday, Jan. 14 at 2 p.m. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes, Behavioral Health Accrediting Organizations, Patient Centered Medical Home Behavioral Health Screening, Behavioral Health and Substance Abuse Services, Developmental Screening Initiative for Primary Care Practices, Acute General Inpatient Hospital Reimbursement, Hospital Potentially Preventable Readmissions (PPR) Program, Reimbursement for inpatient hospital subacute services, The Program of All-Inclusive Care for the Elderly, Central Nervous System/Behavioral Health 2016 Archives, Central Nervous System/Behavioral Health 2017 Archive, Central Nervous System/Behavioral Health 2018 Archive, Central Nervous System - Behavioral Health, Covered Drugs for Dual Eligible Individuals. Provider Network is providers who are contracted to provide health care services by locations, programs, types, and specialties. Provider Services and Tribal Government Relations. This transition would not only be a significant financial risk … What can you do in the Soonercare Provider Portal. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. For people with hearing impairments only, call 1-800-757-5979 (TDD/TTY). How will billing change? This class will provide an in-depth look at the 1500 professional claims submission on the secure provider portal. Printed Name:_____ Nursing Facility Position (LPN, Administrator, etc .) A Prior authorization submission should have the following elements: • A completed prior authorization form • Signed prescription or order Contact. • Services authorized by the PCP must be within the scope of coverage of the SoonerCare Choice program. Due to the risk for anaphylaxis, treatment should only be administered in settings where health care providers have immediate access to medications to treat a severe infusion reaction and the ability to activate the emergency medical system as needed. 1 Nov 2016 – Outlining the Electronic and SoonerCare Provider Portal PA submission changes (effective November 1, 2016). Changes to the provider file will not be possible while enrolled under a manual enrollment. If you do not recognize your site key token, do not type your password. The language change also reflects that the HAN program is no longer a pilot program. This class will provide an in-depth look at the UB-04 institutional claims submission on the secure provider portal. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Children (members under age 14) may choose pediatricians, family medicine, or general practice providers. Provider Resources. Register to attend the UB-04 Claim Submission webinar on Tuesday, Jan. 26 at 10 a.m. at the link below.https://okhca.zoom.us/webinar/register/WN_fa2ceKanS46pyQpPwMyBTQ. General coding for services will not be addressed in this presentation. SoonerCare Therapy Management Program Frequently Asked Provider Questions 1. Oklahoma Health Care Authority’s Vision ... Medically necessary SoonerCare covered services OHCA has opened coverage for the following Covid-19 monoclonal antibodies and administration when used in accordance with the emergency use authorization from the FDA. The state default prescriber ID number will change to 9999999995. The Legal and Finance divisions of the Oklahoma Health Care Authority work together to determine the legal liability of third parties (TPL) to pay for services furnished to Medicaid clients and seek reimbursements for those services. SoonerCare Choice. Effective Dec. 1, OHCA will open coverage for COVID-19 related lab services CPT 87636 and 87637 (see code descriptions below). 1300 McGee Drive Suite 113 Norman, OK 73072. Health Details: OHCA Provider Services Unit is committed to professional and efficient service while maintaining a strong provider base through recruitment, retention and advocacy for the SoonerCare provider community.Our goal is to assist the provider network with claims resolution, programs education, and policy interpretation. Providers are being counted multiple times if they have multiple locations, programs, types, and/or specialties. Starting Address: This section has been temporarily disabled since Maps is currently down and is being worked on. 87637 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza type A and B, and respiratory syncytial virus, multiplex amplified probe technique. Members living near the Oklahoma state border, who regularly see a SoonerCare-contracted provider across the border, should see no changes, as long as the provider’s office is within 50 miles of the Oklahoma border. Experience the Power of Play! After registering, you will receive a confirmation email containing information about joining the webinar. 87636 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza type A and B, multiplex amplified probe technique. The information below is intended as a quick access resource for physicians and other limited practitioners who bill like physicians to obtain accurate and timely Oklahoma Medicaid information. The Oklahoma Health Care Authority's secure portal is intended for providers, clerks and billing agents. Specialty Provider Services (405) 522-7301. more contacts » Q0239 - Injection, bamlanivimab, 700 mg (Eli Lilly) (effective date 11/09/2020)M0239 - Intravenous infusion, bamlanivimab-includes infusion and post administrative monitoring (Eli Lilly) (effective date 11/09/2020)Q0243 - Injection, casirivimab and imdevimab, 2400 mg (Regeneron) (effective date 11/20/2020)M0243 - Intravenous infusion, casirivimab and imdevimab includes infusion and post administrative monitoring (Regeneron) (effective date 11/20/2020)If you have any questions, please call the OHCA provider helpline at 800-522-0114. Content is subject to change. (SoonerCare members who are residents of a nursing facility also may use SoonerRide.) The hospital may … **Please Note: Form must be completed in its entirety or will be considered incomplete and will not be accepted. Provider Services (800) 522-0114 (405) 522-6205. 366.7898 Fax: 405.366.0010 duties. • A PCP referral is not a guarantee of payment. If you navigate away from this page, you will lose unsaved data. 32 4. the term of this agreement shall expire on june 30, 2013. Key information about those benefits is also available below. You may change your provider up to four times per year. To change providers, the recipient must call the SoonerCare Helpline at 1-800-987-7767. Your personalized site key token helps you identify that you are at the valid SoonerCare Portal site. Location. SoonerCare Language; Provider Resources; Home > Providers. When a member has an approval for services and wants to switch providers, a new request from the new provider must be submitted and include: HCA-13A– Completed Prior Authorization Attachment Form Cover Sheet Instructions (link) OHCA has opened coverage for the following Covid-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA: 91300 - Pfizer BioNtech Covid-19 vaccine (effective date 12/11/2020)001A - Pfizer BioNtech Covid-19 vaccine administration - first dose0002A - Pfizer BioNtech Covid-19 vaccine administration - second dose, 91301 - Moderna Covid-19 vaccine (effective date 12/18/2020)0011A - Moderna Covid-19 vaccine administration - first dose0012A - Moderna Covid-19 vaccine administration - second dose. These letters do not change anything for you or your coverage! 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