Prior authorization changes continue for SoonerCare

Posted on: 5/9/18


Effective June 4, the Oklahoma Health Care Authority (OHCA) will embed InterQual® evidence-based questions and answers for certain imaging and pain management prior authorization (PA) requests into the SoonerCare Provider Portal PA function. The transition will take place during the next 12 months and will include most medical PA requests.

OHCA announced last fall the embedding of InterQual guidelines into their PA processes. In December, OHCA began a pilot program for authorizing hip and knee replacement surgeries using this tool.

Also effective June 4, the OHCA will implement near real-time adjudication (15 minutes or less) for certain imaging study PAs. To accomplish this, imaging PAs will require electronic attachments upon submission that support the PA request.

The InterQual® process and adjudication changes will be covered in the spring Provider Training events being held in May and June. OHCA encourages all medical providers to sign up for a training session near them in order to prepare for these upcoming changes. You can sign up on the OHCA Training webpage.

If you have any questions about these PA process changes or the InterQual® implementation, please call the OHCA Provider Helpline at (800) 522-0114. (Rick Snyder)

Save the dates for OHA 2022 events

Posted on: 2/18/22


It’s a new year and a new lineup of important events for you and your staff. Don’t miss out on these opportunities to engage in advocacy, education and networking all year long. Mark your calendar now!

OHA Advocacy Day - Tuesday, April 5, Oklahoma History Center. Join us for our annual legislative day. We will begin with a member briefing at 3 p.m., followed by a legislative reception at 5 p.m. Watch for registration materials soon.

OHA-PAC Golf Tournament - Tuesday, June 21, Jimmie Austin Golf Club at OU, Norman. Time and details TBA.

OHA Health Care Leaders Forum - Tuesday, July 19 - Thursday, July 21, Shangri-La Resort, Grand Lake. Watch for registration soon!

OHA Connect 22 - Wednesday, Nov. 9 - Friday, Nov. 11, Oklahoma City Convention Center and Omni Hotel, downtown Oklahoma City. Plan now to attend OHA’s annual conference and exhibit hall. More details to come.

Details on these events and other upcoming education opportunities will be available on the OHA website.