SoonerCare provider update, winter 2013

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SoonerCare Provider
Update
Winter 2013
Increased SoonerCare Payment for
Primary Care Providers
The Affordable Care Act (ACA) directs Medicaid agencies to reimburse certain primary care providers
for Evaluation and Management (E&M) and vaccine administration codes at 100 percent of the
Medicare rate during calendar years 2013 and 2014. Physicians in primary care specialties and
subspecialties are eligible for higher payments, as well as physician assistants and advanced practice nurses
who work under an eligible physician’s personal supervision.
Eligible specialties are family medicine, general internal medicine or pediatric medicine and all subspecialties
within those designations as recognized by the American Board of Medical specialties, the American
Osteopathic Association, or the American Board of Physician Specialties. Providers can verify and/or update
their specialties on the Provider Secure Site.
To receive the higher payments, physicians must complete an amendment to their SoonerCare Provider
Agreements by March 15, 2013 and attest to either:
1. Board certification in one of the eligible specialties or subspecialties, or
2. That 60 percent or more of the physician’s codes billed or paid by Medicaid in calendar year 2012
were for included E&M and vaccine administration codes.
Claims for dates of service beginning Jan. 1, 2013 are eligible for the higher payments. OHCA will make the
higher payments at the end of each quarter by adjusting all paid claims for the included codes to the higher
rate with the net amount deposited to your account. The first adjustment will occur in April 2013; the claims
adjusted will be identified with EOB 8147.
Providers may access more information and the required amendment on the Provider Enrollment website.
You may also call the OHCA Provider Helpline at 800-522-0114, option five, with any additional questions.