Oklahoma Healthcare Authority launched Sooner Select, the long-awaited new health care delivery system on April 1, 2024.
Who is included in SoonerSelect?
The following SoonerCare populations must enroll in SoonerSelect:
- Low-income parents
- Pregnant women
- Adults age 19-64
- TheSoonerSelect Children’s Specialty Program includes children in foster care, former foster children up to age 25, juvenile justice-involved children, and children receiving adoption assistance.
Below is a summary of some of the FAQ’s provided on the OHCA website, a full list is available at https://oklahoma.gov/ohca/soonerselect/provider-resources/faqs.html#accordion-5abd25c3ee-item-298464796f.
What is a CE?
You will hear the term CE’s many times as your practice becomes involved in this. A CE is a contracted entity. The CE’s for Oklahoma are Aetna Better Health, Oklahoma Complete Health and Health Horizons (Humana). As a contracted provider with OHCA, you can participate in all three or none.
What will the reimbursement be?
Each CE will continue to pay providers for the services they are rendering. CEs will also pay providers who may be outside their network at the same rate as their own providers for the first 90 days after launch. After this period, all contracted providers will receive 100% of the reimbursement rate for the applicable service based on OHCA’s fee schedule until 2026. Providers will have the opportunity to enter into value-based contracts with the CEs.
How will credentialing work?
To make the transition to SoonerSelect easier on the provider community, from now until July 1, 2025, all SoonerSelect CEs will approve providers actively enrolled with OHCA without requiring full credentialing. Providers must still be contracted with each CE that is serving the provider’s patients transitioning into SoonerSelect, but providers will not have to go through full credentialing until July 1, 2025.
How will OHCA handle PA’s to the CE’s?
The CE will ensure all PAs for covered benefits in place on the day prior to the enrollee’s enrollment with the CE remain in place for 90 days following an enrollee’s enrollment. During this90-day continuity of care period, PAs may not be denied on the basis that the authorizing provider is not a participating provider. Payment to non-participating providers shall be made at the current Medicaid fee schedule rate and in accordance with OHCA’s payment timeliness standards during the continuity of care period.
The above information has been gathered from CE resources and the on line OHCA website and is general to all. If you have concerns about continuity of care and reimbursement, below is the link for provider information which provides guidelines and resources for managing these patients in your practice. Each CE provides training and sessions, your staff is encouraged to take the time to prepare or decide on how to work with this transition.
- Billing and Provider Manual
- New Provider Orientation
If you have question about how this impacts you, please feel free to call us at 405-210-7234. We are happy to help you.
