1. SoonerCare A brief overview November 2009

2. SoonerCare A brief overview Agenda  Programs  Eligibility  Billing  Resources

3. SoonerCare A brief overview Programs  SoonerCare Traditional  SoonerCare Choice  SoonerCare Supplemental  Oklahoma Cares (BCC)  Perinatal Dental Program – PDEN

4. SoonerCare A brief overview Programs, cont.  SoonerPlan (Family Planning Waiver)  SoonerRide (NET)  Home and Community Based Waivers  Insure Oklahoma/OEPIC Individual Plan  Soon to Be Sooners

5. SoonerCare A brief overview Eligibility Process and Verification  Member files application with Department of Human Services (DHS) of Human Services (DHS)  Local DHS office processes application and enters approval or denial into OKDHS mainframe enters approval or denial into OKDHS mainframe  Real-time update to the Medicaid Management Information System (MMIS) Information System (MMIS)

6. SoonerCare A brief overview Eligibility Verification  There are four methods to verify eligibility:  SoonerCare Secure Site  Eligibility Verification System (EVS)  Electronic Date Interchange (EDI)  Swipe Machine

7. SoonerCare A brief overview Claim Submission  Claim Submission Types  SoonerCare Secure Site – Direct Data Entry (DDE)  Electronic Submission (EDI)

8. SoonerCare A brief overview Resources  OHCA Policy and Rules  CD Rom  Website – www.okhca.org  Provider Billing and Procedure Manual  HIPAA Companion Documents

9. SoonerCare A brief overview Resources, cont.  On-site assistance  OHCA Provider Services  877-823-4529 option 2  HP  6 Regional Field Consultants  Quick Reference Guide

10. Questions

11. SoonerCare Web Training and Billing Tips

12. Eligibility Suzie 012345678 Sue

15. Utilizing the SoonerCare Secure Site 012345678

17. 200000000 Claims

19. Outpatient

21. Adjustments 100123456

22. Resolving Denials

23. Did you know…  When using the ICN to research a claim, no other information is required. The ICN is specific to only one claim.  Using a member ID and the date of service will narrow the search results.

24. Medical Center Hospital 100123456A Resolving Denials

25. 012345678 2208000001234

26. 012345678 2008999999999 2008000000000 1008999999999

27. 2208000001234

28. A new denial code (N84) will be used for DMHSAS services only. If a service is denied because the 1/12th cap has been met, the service will be denied with a N84 denial code.

29. Internal Control Number  ICN Internal Control Number identification Logical format Logical format 2209019395865 2209019395865 22 – region code22 – region code 09 – year09 – year 019 – Julian date019 – Julian date 395865 – claim sequence395865 – claim sequence

30. Internal Control Number, cont.  ICN Region code examples: 10 Paper Claim 10 Paper Claim 11 Paper Claim with an attachment 11 Paper Claim with an attachment 20 ASC X12N 837 electronic submission 20 ASC X12N 837 electronic submission 21 ASC X12N 837 electronic submission with attachment 21 ASC X12N 837 electronic submission with attachment 22 Web claim submission (DDE) 22 Web claim submission (DDE) 23 Web claim submission with attachment 23 Web claim submission with attachment 50-59 series - Adjustment 50-59 series - Adjustment 90-95 Special process request 90-95 Special process request

33. SoonerCare Questions