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)

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