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.
Clarification Regarding Prior Authorizations Requests (PARs) via the Provider Portal:
We have become aware that during recent Provider Training addressing the new Provider Portal, confusion was created regarding the PA Process handled by the Medical Authorization Unit (MAU).
The process for submitting a PAR to the MAU has not changed. We require the same information to be submitted, regardless of whether the request is submitted via fax or using the Provider Portal.
Required documentation:If you are entering a PAR via the Provider Portal, you will still need to submit the following:1. HCA-12A or a copy of the on-line PA Authorization screen or you may save a copy of this screen as a WORD document and attach it to the PA when you are uploading your documentation (The MAU staff are not able to view this information in our PA Workflow System).
For High Risk OB requests, the completed CH-17 form is still required.
Therapy PARs: The rendering/servicing provider should be the individual provider ID# or NPI of the therapist who will provide the services. Claims will not pay if a group ID is listed, as the individual licensed professional must file the claim.
2. The MAU requires a script or order from the treating provider for ALL PARs.
3. CMN (Certificate of Medical Necessity): If required, please see the section regarding Forms.
4. Required documentation: Please refer to the individual sections on the OHCA Public Webpage for pertinent information (www.okhca.org, Providers, Medical Authorization Unit, scroll to the necessary section, click to view information).
5. Photos can be scanned and upload in the same manner as uploading documents. Unfortunately, videos still require delivery via mail service.
We encourage you to use the Provider Portal to submit your PARs with the uploaded documents, as this reduces the potential for problems we have experienced in the past with providers faxing documents, especially legibility issues. For further information, please contact the MAU @ (800) 522-0114
Provider Portal Tip: For Internet Explorer users: If a provider or clerk is getting kicked out of the portal and back to the Log In Screen, please update your pc settings into compatibility view to help optimize the site.
From the Log In page: Under Tools>Compatibility view: Click Add this website(www.ohcaprovider.com) to Compatibility View. The page should refresh and you should be able to proceed as normal.
As we are moving from paper referrals to the electronic referral system available through the portal, please keep in mind that the new system was only designed to replace the SC-10 form (paper referrals). The new referral will allow OHCA to track specialty utilization and allow claims to process. You will need to continue to send additional information that was requested from the specialist. This includes contact information for the members, face sheets, office notes etc. for continuum of care, for these members. Also, please note when submitting a new referral from the new provider portal, PCP's should confirm the related NPI and address of the specific specialist that is being referred to. OHCA and HP are still reviewing ways to improve this new process. In conclusion, at this time paper referrals are still accepted through March 31st 2014.
Please be advised that due to issues regarding the new OHCA provider portal, we will allow claims submissions up to 12:00 PM on Thursday 02/06/2014. There will be no impact to the payment date.
Thank you for your support as we continue to work through the issues related to the provider portal
OHCA will be able to accept the new paper 1500 forms starting January 6, 2014. We will be able to process both claim forms through March 31, 2014. Effective April 1, 2014 all 1500 claims filed must be on the new 1500 form regardless of the date of service.
What can you do in the Soonercare Provider Portal
The Oklahoma Health Care Authority's secure portal is intended for providers, clerks and billing agents. 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.