complete an interview with a DHS worker and answer some additional eligibility questions. VIII of, Appendix C-1, Maximum Income, Resource, and Payment Standards, After you submit the online application or the. You may call the automated 4 Close to 12% of Medicaid recipients over the age of 18 have a substance use disorder. However, if you have proof of Medicaid (SoonerCare) or Medicare enrollment, the cost is reduced to $20. Yes, you can call Soonercare at 800-987-7767 to order by phone. to do so. Provider Types/Specialties: 31, 52/328, 335, 568. Step 2 When you get to the login page, enter your user ID or email address followed by your password in the fields below and click Login. Oklahoma City, Ok73105 2011 Global Messages If you have any questions about completing the survey, please call 918-619-6174 for assistance. Furthermore, based on the definition of modifier 91, it should not be reported when the basic procedure code(s) indicate that a series of tests are to be obtained. Please review the full guideline located at Durable Medical Equipment (oklahoma.gov), Nursing Facility Pay for Performance (PFP) Payment Update, Allowance of Complete Dentures Five to Seven Years after Approval of Immediate Dentures, Injection of biodegradable material next to prostate, CPT Code 55874, Molecular Diagnostic Testing for Infectious Diseases, Hospice services for Expansion Adults in long term care facilities, SoonerCare Eligibility Through NODOS or eNB-1 Webinar, Patient-Centered Medical Home (PCMH) Obesity Performance Measure, Qualifying Clinical Trials CMS Attestation Form, Pricing for Q0222 COVID-19 Monoclonal Antibody Bebtelovimab, Changes Impacting July 2022 SoonerExcel payments, Modifier 25 and 59 Medical Review Bypass Code Lists for Professional Claims, Fluoride Varnish Quality Improvement Project, Patient-Centered Medical Home (PCMH) Behavioral Health Screening and Performance Improvement Project (PIP) Reporting, Dental Benefits for Members in Long Term Care Facilities, Coverage of Insertion/Removal of Permanent Leadless Pacemaker, CPT Codes 33274/33275, Hospice Services for Expansion Adults in Long Term Care Facilities, Patient-Centered Medical Home (PCMH) Redesign Obesity Performance Measure and New Provider Scorecards, Physical Therapy and Occupational Therapy Use of SC Modifier Clarification, RE: PCMH Mock Audits for Compliance Reviews, Dental Prior Authorization and Amendments Webinar, Electroencephalogram (EEG) in Inpatient Facility, LTC Cost Report & QOC Submission Training Webinar. proof listed below. online through OHCAs Online Enrollment system, you will immediately be told who The Oklahoma Health Care Authority is presenting a webinar for providers that will give a high-level overview of Oklahoma Medicaid, known as SoonerCare. No, to qualify for Medicaid expansion you cannot have Medicare or be entitled to Medicare. Visit the provider training page for a how-to video on renewing your SoonerCare contract. Please make an appointment with your PCP after you are approved for SoonerCare. qualify. You can also choose to use Providers will be compensated for providing the following dental codes when medically necessary. Ephrata Recreation Center. Effective Dec. 15, 2022, OHCA will begin using DocuSigns secure digital signature technology for SoonerCare provider contracting. Effective April 1, 2022, CMS has developed two new diagnosis codes to report underimmunization for COVID-19 status. OHCA will present a webinar titled 2022 Patient Centered Medical Home (PCMH) Redesign on Tuesday, March 8 at 2 p.m. and Thursday, March 24 at 2 p.m. Each month your cost sharing limit will resetautomatically. The increase in the aggregate for children is over 5%, and for adults over 14%. Agree to cooperate in pursuing child support services against the parent who is absent from the home, unless good cause is established by Oklahoma Child Support Services. Experiencing Difficulties? SoonerCare is insurance that helps pay for medical care. Long-term care provider cost reports for SFY22 are due by Oct. 31, 2022. If you still have problems after that, please contact customer service. Provider Types/Specialties: 08/081, 082, 086; 27/270-279. 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. If you have a medical emergency, you should call your home health care provider. Reimbursement will be paid to contracted pharmacies that dispense the test kits to a SoonerCare member. Provider Types/Specialties: 27/270-279, 08/080-081 & 086. You will need to bring proof of identification, income Provider Letter 2022-01 was sent on Jan. 25, 2022. If a change of ownership has occurred and you have an entire year of data available, then the two partial reports must be combined and entered in the Provider Portal. Thank you for the services you provide to SoonerCare members. Please reference provider letter 2022-10 Re: Dental Benefits in Long Term Care Facilities. This reduces the risk of medication error. This means your copays to yourprovider orpharmacy will never total more than your households cost sharing limit a month. Yes. 2008 Global Messages These benefits provide basic, medically necessary dental treatment. Provider Types/Specialties: 010, 014, 312, 313, 341, 342. day. To apply for free or reduced price meals, contact your child's school. Pregnant women who participate in WIC receive prenatal care earlier, Children who participate in WIC are more likely to have a regular source of medical Provider Types/Specialties: 01; 63/633, 634, 635; 11/138. If you do not know if a service is covered by SoonerCare, ask your provider or call the SoonerCare helpline at 800-987-7767. OHCA will present a webinar titled "LTC Cost Report & QOC Submission Training on Thursday, June 9 at 10 a.m. When will Medicaid Expansion go into effect? Click OHCA has provided a list of procedure codes that do not require documentation review when billed with modifier 59/XE/XP/XS/XU to indicate a procedure or service was distinct or independent from other non-evaluation and management (E/M) services performed on the same day. Community Resources: All Nursing Managers and Practice Facilitators have access to a Community Resource Specialist to help members find appropriate resources. If you have any questions, please call the OHCA Provider Helpline at 800-522-0114. The following contracts expire June 30, 2022: Pharmacy, DME and medical supplies. Mavyret no longer requires a prior authorization (PA) for SoonerCare members diagnosed with Chronic Hepatitis C. OHCA removed ALL PA documents required for this specific direct acting antiviral (DAA) Hepatitis C treatment. Provider Types/Specialties: 08/082, 088, 184, 185; 31/316, 318, 322, 344, 345, 568; 10/100; 09/093. at the customer service counter where you can swipe your card to check your balance. RD/LDs are nutrition experts available through the WIC Program and are It is a limit of total copays monthly. 2016. The video is located under the SoonerCare How-To Videos dropdown titled Renewing your SoonerCare contract. I just started my job and my employer will not give me proof of my income. disabled if you want to receive a medical deduction. Note: This webinar does not contain information on using InterQual review and is not recommended for behavioral health, dental or waiver providers. Other DAA treatments for Chronic Hepatitis C will continue to have the same PA requirements which can be found at www.oklahoma.gov/ohca/pa in the Hepatic Disorders therapeutic category. As a reminder, inpatient facilities can apply through CMS for the ability to provide some inpatient services to patients in their home. Note: Referrals submitted through the OHCA secure provider portal by I/T/U providers to specialists will not be covered. The Oklahoma Health Care Authority is presenting a webinar for chiropractors on Thursday, April 21 that will provide information about the SoonerCare provider contract process and includes helpful resources for providing Oklahoma Medicaid services. The application fee is $100. Creating a new account on the Soonercare login portal is very simple. or older, persons who are under 19 2, 2022, at 2 p.m. When you first apply for food benefits, you will need to provide a document to 4 You can also call the SoonerCare helpline at 800-987-7767. For your convenience, we have provided a link to the PFP Payment Summary worksheet, along with contact information, should you have questions regarding the program or payment details. After clicking on it, you will be redirected to a new page. Registrants unable to attend the webinar session should notify [emailprotected] to cancel their registration. Apply by phone by calling the SoonerCare Helpline 800-987-7767. Your households total monthly WebBoth adults and minors with qualified medical conditions can consume cannabis products so long as they have a valid medical marijuana card. Provider Types/Specialties: 08, 09, 10, 16, 27, 31, 52. OHCA also covers Evusheld (tixagevimab co-packaged with cilgavimab) for the pre-exposure prophylaxis of COVID-19 for adults and pediatric members 12 years of age and older (weighing at least 40kg) with no known COVID-19 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s). Requests submitted with a group number will not process through any of the automation steps. Your SoonerCare benefits are limited if you do not opt for a PCP/CM. The global message dated March 19, 2021 provides instructions on how to complete the PIN reset form. 4 Close to 12% of Medicaid recipients over the age of 18 have a substance use disorder. WIC gives information about healthy eating and promotes active lifestyles! For general questions and information for SoonerCare members, call the SoonerCare Helpline at (800) 987-7767. By bypassing the states general fund and the voter-approved Prop 98 Some stores have a machine care for your child. OHCA is currently asking all members to update their contact information and contacting those members at risk of being ineligible due to missing information. See OAC 317:30-5-20 Laboratory Services for more information. What other types of treatment do we have as an option? Microsofts Activision Blizzard deal is key to the companys mobile gaming efforts. Once DHS receives the Request for Benefits form, you will be contacted regarding PFP payment calculation questions contact: We thank you for your continued service to SoonerCare members. Visit the provider training page for a how-to video on renewing your SoonerCare contract. State Department of Education. You must call the SoonerCare Phone Number at 800-987-7767 to select your medical facility. For general questions and information about SoonerCare (Medicaid), persons 65 years of age Contact your child's school for more information. Likewise, OHCA has also provided a list of E/M codes that do not require documentation review when billed with modifier 25 in conjunction with certain procedure codes to indicate a significant separately identifiable service was performed on the same day. rules. If they find a match, an email will be sent to your registered email address. OHCA is encouraging providers to complete a brief questionnaire so we may assess and increase provider awareness of care coordination services available to members with higher levels of social and health care needs. OHCA will present a webinar titled PCMH Obesity Performance Measure on Thursday, October 13 at 2 p.m. No prior authorization required. Visit the OHCA Provider Training page to register to attend theClaim Processing Updates for Outpatient Facilitieswebinar onThursday, April 28, 2022 from 2 p.m. to 3:30 p.m. or on Thursday, May 5, 2022 from 2 p.m. to 3:30 p.m. to attend the appointment. Household Summary This page will give you a summary of all the people in the case. Providers must submit Form HCA68, along with supporting documentation that medically justifies the need for the use of donor breast milk. Whenever you use your ACCESS In general, the following groups of individuals may qualify for SoonerCare services: Adults with children under 19; Children under 19 and pregnant women; Adults, not eligible for Medicare, age 19-64; Individuals 65 and older; Individuals who are blind or who have disabilities; Women under 65 in need of breast or cervical cancer treatment Find a provider by using the, You may choose a family child care home or a child care center that has a license Effective Dec. 30, 2021, OHCA will allow reimbursement for long-acting reversible contraceptives (LARC) in addition to the FQHC encounter rate. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes. If additional providers are needed, your PCP will help you. Both these lists and other information regarding NCCI edits can be found on the OHCA NCCI webpage at https://oklahoma.gov/ohca/providers/national-correct-coding-initiative.html. In an effort to increase the use of Fluoride Varnish (FV) in the primary care setting,OHCA would like to share best practice workflows obtained through research by asking for participating clinics to record their FV application rate for a month and gather the data for the continued improvement process. When providers are reporting CPT 99401 to report COVID-19 vaccine counseling for children ages 0-20, they should now also bill with either of these new applicable diagnosis codes. Due to therisk ofanaphylaxis, 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. you will receive a letter scheduling an interview. These individuals work with practice to implement a health information management tool to collect data and assess quality and performance to ensure evidence-based guidelines are followed. The Quality Assurance (QA) department at the Oklahoma Health Care Authority will be conducting mock audits for medical record compliance review as a part of ongoing efforts to innovate the SoonerCare Choice Patient-Centered Medical Home (PCMH) program. or by contacting the Oklahoma Child Care Resource and Referral I have SoonerCare, can I make an appointment with my primary care provider (PCP)? 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. All cancelled prior authorization requests must be resubmitted as a new request. More information on the appropriate use of modifier 91 can be found at the following link: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00144503#:~:text=Print-,Modifier%2091,Lab%20services%20examples%3A,-Line%201%20%3D%2084132. OHCA has updated our Patient Dismissal Process. Step 1: Open theOnline Enrollment Home View Presentation. This presentation provides information about approved behavioral health screening tools, coding guidance, best practices, and offers behavioral health resources for PCMH providers. Provider Types/Specialties: Extended Care Facility (03)/(030) Nursing Facility, (031) ICF/IID > 6 beds, (034) ICF/IID < 6 beds & (035) Skilled Nursing Facility. The rate increase will not apply to orthodontic procedures. given birth, 2. Nutrition Assistance Program (SNAP), Child The FDA has removed the emergency use authorization (EUA) for this treatment as it is no longer expected to be effective against the dominating strains of COVID circulating at this time. office during business hours when you are applying for other DHS benefits. Effective immediately, providers can now submit their amendment requests through the secure provider portal. As soon as you can, call your PCP and alert them of the emergency. Sometimes it is hard to know what to ask. The income eligibility limits vary based on family size and amount of income.Two-person families can make up to $3,668/month, three-person families can make up to $4,530/month, and four-person families can make up to $5,393/month. If you do not know if a service is covered by SoonerCare, ask your provider or call the SoonerCare helpline at 800-987-7767. Target Audience: Chiropractors providing alternative treatments for pain management to SoonerCare adults. Target audience: SoonerCare Choice Patient-Centered Medical Home providers. The extension is effective through April 30, 2023. Effective Dec. 5, 2022, OHCA has closed coverage for COVID monoclonal antibody treatment Bebtelovimab, reported by codes Q0222 and M0222. Experiencing Difficulties? To schedule a ride, call 877-404-4500. Additionally, providers unable to access the OHCA secure provider portal to submit a contract renewal must complete a PIN reset form. 2021 Global Messages Agency Partners should contact the number above and then select option 4 and enter their PIN to access the Agency Partner Helpline. OHCA covers the following COVID-19 vaccines and administration when used in accordance with the emergency use authorization (EUA) from the FDA: OHCA covers the following COVID-19 monoclonal antibodies and administration when used in accordance with the emergencyuse authorization (EUA) from the FDA. A listing This is a step-by-step guide that will assist you in viewing instructions of the application at the same time actually filling out the application. The standard copay is $4.00 per visit. Implementing a tobacco-free environment is beneficial to employees, patients, and visitors as it supports the creation of a safe and healthy workplace, helps protect against second and third hand smoke exposure, and encourages people to quit. Please read the terms and conditions carefully, to apply for SoonerCare Benefits, you must select I Agree to complete the soonercare application. If members have received a letter from OHCA requesting information, they need to respond immediately. Immediate dentures are allowed one (1) per arch per lifetime. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. $119.99. Prior authorization is required for ages 10-24. or by going to your local You may also view the C-section rate release schedule on the OHCA webpage at www.okhca.org/c-section. are eligible for free meals. Please complete this SCD needs assessment survey no later than April 15, 2022. 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. A listing Monoclonal antibody infusion is reimbursable when provided in a hospital outpatient department or physicians office experienced in infusion services. Register to attend the OHCA School-Based Services webinar from 2-3:30 p.m., Wednesday, November 2. It is not appropriate for a provider to bill for lab testing they refer to another laboratory to perform. Can you apply for Soonercare over the phone? Providers will be prompted to use DocuSign to electronically sign new and renewal provider applications. SoonerCare will keep track of this for you. Follow the steps below to SoonerCare Sign In. That would mean you are responsible for paying copays at your appointments and at the pharmacy until your totalcopayshit $25in the same month. Some services may require prior approval from the rendering dental provider. Apply through one of our agency partner facilities. SoonerRide is for non-emergencies only. It is not used when laboratory tests or studies are simply rerun because of specimen or equipment error or malfunction. Please feel free to send comments and questions to [emailprotected], Provider Types/Specialties:08/087, 17/170-171, 174-175. A brief update on PIP reporting requirements will be provided. This will be the only acceptable way to submit such request starting June 10, 2022. income is within the income guidelines listed below. benefit for you to buy food. Microsoft is quietly building a mobile Xbox store that will rely on Activision and King games. Each facility must apply individually. The Oklahoma Health Care Authority (OHCA), to eliminate Hepatitis C in the SoonerCare population and lessen the burden for our providers, has entered into a Value-Based Agreement with AbbVie, the manufacturer of Mavyret. Fill out an English or Spanish paper application and mail it to the address on the application. The Women, Infants, and Children Supplemental Nutrition Program (WIC) provides The Secretary of Health and Human Services announced the COVID-19 public health emergency (PHE) has been extended for 90 days, effective April 16, 2022. Provider Specialties: 087, 170, 171, 173, 182. The focus will be on the needs of medical providers. 2018 Global Messages The compensation for the LARC will be at the current fee-for-service rate. The use of the SC modifier is appropriate when submitting a physical therapy or occupational therapy prior authorization request for initial post-operative surgeries and acute injuries. However, for minors, they must also have a caregiver. Websoonercare provider portal Bubble Tent. The person receiving the benefits will need If you make $0 a month, your cost sharing limit would be $0. To log into your account online, follow these simple steps: Step 1 Go to the Soonercare login page: www.oklahoma.gov/Site/UserAccountLogin.aspx. This will allow you to follow the step by step guide on How to Apply presentation and the actual application at the same time. When providing a COVID-19-related service, providers should include one of the following diagnoses on their claim (when appropriate): For any questions regarding COVID-19-related copay or billing issues, please call the OHCA provider helpline at 800-522-0114. than $150.00 in monthly gross income and you do not have cash resources over $100.00. After the implementation of ClaimXTen, providers noticed changes to the way their claims were processed versus information submitted on the claim. WebFight for a progressive future by growing and wielding the grassroots political power of young people; Build power on the ground and online for the youth vote WebCash assistance is available to the family on a time-limited basis through TANF. 130 South Academy Drive, Ephrata, PA 17522. You may call the Oklahoma Department of Education at: 405-521-3327 for more information. Medicaid sometimes covers preventive dental treatments for adults. hyperlink to learn more about the programs. 9-11:30 a.m. 12:30-3 p.m. 3-5:30 p.m. Wednesday, Dec. 14, 2022: etc.). To use the SoonerCare Login Portal, you must create an account, including a username and password, with which you will log into the system.
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