HealthChoice changing certification and hospital transfer policies

Posted on: 5/3/17

HealthChoice, the state of Oklahoma’s health plan for state and education employees, is updating its certification (authorization) requirements for imaging and pacemaker/defibrillator procedures.  

Effective July 1, 2017, HealthChoice will required certification for all CT scans, MRIs, MRAs, PETC, SPECT, and outpatient pacemaker/defibrillator procedures.

For a list of the codes added to the certification requirement, click here.

Questions should go to the HealthChoice certification administrator, at (800) 848-8121. To view the HealthChoice Provider Manual page on certification, click here.

Also effective July 1, 2017, HealthChoice will change their calculation of the allowable fee paid to facilities transferring an inpatient to another hospital. The formula for the fee will be: (MS-DRG allowable fee/geometric mean length of stay) x (length of stay + 1 day).

The total transfer allowable fee paid to the transferring facility is capped at the amount of the MS-DRG allowable fee for a non-transfer case. HealthChoice will allow payment to the receiving facility, if it is also the final discharging facility, at the MS-DRG allowable fee as if it were an original admission. (Rick Snyder)

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