Oklahoma SoonerCare Update SoonerCare Main Telephone Numbers OKC Metro (405) 522-7366 State-wide Toll Free 1-877-823-4529 OHCA Website: www.ohca.state.ok.us
July 27, 2005
Dear Provider: Pharmacy Updates to Assist SoonerCare Contractors
Oklahoma Medicaid Pharmacy Update
Pharmacy Help Desk Telephone Number 405-271-6349 or 1-800-831-8921
Service Hours: Monday – Friday (8:30a – 7:00p); Saturday (9:00a – 5:00p); Sunday (11:00a – 5:00p)
Email: [email protected] OHCA Website: www.ohca.state.ok.us Borrowed from theJuly 8, 2005, edition NEW QUANTITY LIMITS (Effective July 11, 2005) Antidepressants 100mg – 3 units per day up to 100 units
30mg, 60mg –1 unit per day up to 100 units
SoonerCare Provider Update July 28, 2005 Page 1 of 3 Antipsychotics
25mg, 100mg, 200mg - 3 units per day
300mg - 2 units per day up to 100 units
A complete list of Quantity Limits can be accessed at the following link:
http://www.ohca.state.ok.us/provider/pharmacy/billing/limits.htm
Note: Quantity Limit and Early Refill Overrides can be initiated verbally by calling the Pharmacy Help Desk
Borrowed from the July 22, 2005, edition Dear Pharmacy Provider, ProDUR HIGH DOSE ALERT Beginning August 8, 2005, Oklahoma Medicaid will begin to deny claims submitted with doses greater than two times the FDA recommended maximum dose. Please submit the correct day supply, so that, the submitted claim does not deny due to error. If a ProDUR High Dose Alert is received, a prior authorization may be requested by submitting a Statement of Medical Necessity for Quantity Limit Override form. All pharmacy forms can be accessed at the following link: http://www.ohca.state.ok.us/provider/pharmacy/billing/forms.htm Medicare Part D Prescription Drug Coverage Medicare Part D and Extra Help – Medicare Part D Prescription Drug Coverage will go into effect on January 1, 2006. Some of your clients will qualify for a program called “Extra Help”. This program pays the premiums and co-pays for eligible recipients. The Social Security Administration is currently mailing letters and “Extra Help” applications to Medicare recipients. Some of your customers may bring these applications to you for assistance. Please direct them to the Social Security Administration for help in completing the applications and any other Medicare Part D questions. SSA can be reached by calling 1-800-Medicare.
Medicare Part D Drug Coverage Important Dates July 2005 – Extra Help with Drug Plan applications accepted by SSA. September 15, 2005 – CMS announces Prescription Drug Plans (PDP). October 2005 – Dual Eligible recipients notified of automatic qualification of Extra Help and plan SoonerCare Provider Update July 28, 2005 Page 2 of 3 November 2005
– Open Enrollment Begins and runs through May 15, 2006.
December 31, 2005 – Medicaid drug coverage ends for dual eligible recipients. January 01, 2006
– Medicare Part D Drug Coverage and Benefits BEGIN.
Useful Pharmacy Information on the OHCA Public Website Pharmacy
¾ Prescriber File (PDF Adobe File Format)
¾ Prescriber File (Microsoft Excel Format)
http://www.ohca.state.ok.us/provider/pharmacy/pharmrx.htm Thank you for your continued service to Oklahoma’s Medicaid clients.
Providers with questions about prescription limits are invited to call the Pharmacy Help Desk at -271-6349 or 1-800-831-8921 for assistance.
SoonerCare approval to fire required in advance Providers are reminded that key steps must be followed in seeking approval to dismiss a SoonerCare member, as noted in Article 4 of the contract. The contractor may not notify the member of a change until the contractor has received an approval to dismiss from SoonerCare. The contractor may, however, notify the member that disenrollment has been requested. Questions about disenrollment requests may be directed to your SoonerCare provider representative by calling toll-free, 1-877-823- 4529, option 2. Phone renewals now accepted
To assist with continuity of care by maintaining beneficiary eligibility, the Oklahoma Department of Human Services (OKDHS) has adopted a new option for renewals for certain individuals. Those who receive SoonerCare, have Medicaid as their only OKDHS eligibility and are categorically related to Aid to Families with Dependent Children may now review benefits by telephone. When members of the household receive other benefits, the standard benefit review process is required. SoonerCare Provider Update July 28, 2005 Page 3 of 3
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