02132013 Newsletter 4[1] 1 |
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1 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.
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Title | 02132013 Newsletter 4[1] 1 |
Full text | 1 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. |
Date created | 2013-06-20 |
Date modified | 2013-06-20 |