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If your patients have questions, please refer them to the website for the latest news and updates. Title: Dear Provider Letter 2017-35 Provider Letter 2017-35 serves to inform providers about the implementation of Inter Qual guidelines in the prior authorization request process.
Please post all comments by close of business Monday, December 18, 2017, via the Oklahoma Health Care Authority Policy Change Blog.
Multiple changes will go into effect on Jan.1, 2018, and it is important to note the following: Mammography services –The 2017 CMS G-codes for diagnostic and screening mammograms and bundled computer-aided detection (G0202, G0204 and G0206) have been deleted.
Screening mammography, bilateral (2-view study of each breast), including computer-aided detection when performed.
Initial Visit Report for Care Coordination Payment As previously posted, effective January 1, 2018, the Oklahoma Health Care Authority (OHCA) began to only pay care coordination fees for members who have visited their assigned provider within the past 15 months. To assist providers in identifying members who have not established a provider-patient relationship, OHCA will furnish medical home providers a listing of members who have either not established this relationship or are within 45 days of reaching the 15-month mark.
Standardized code sets are necessary for Medicare and other health insurance providers to provide healthcare claims that are managed consistently and in an orderly manner.
The code set is made up of five-character, alpha-numeric codes mainly representing medical supplies, durable medical goods, non-physician services, and services not represented in the Level I code set (CPT®).