Welcome to the Oklahoma SoonerCare Program okhca

Welcome to the Oklahoma

SoonerCare Programwww.okhca.org

This introductory CD will walk you through the process of setting up your provider account on our secure website and how to submit a professional claim through direct data entry.

Go to: www.okhca.org

Log on ID is provider legacy

number

PIN information is listed on provider

welcome letter

To access the claim forms, click

on Claim Submission

The 1500 claim form, is called the

Professional

To begin, enter the

client ID and hit tab.

If your service requires a referral, enter the NPI of the Referring physician

Enter the primary

diagnosis code with no decimal

point. If additional

diagnosis codes are needed, hit

tab.

Dates will

populate as you fill out the claim

lines of service

Continued

Enter the amount paid, if the client had another

insurance that paid primary to SoonerCare

Enter Yes, if the client had another insurance that

denied the claim. **attachment will be

required.

CLIA Number goes in this field, only

when billing a procedure code that requires a CLIA number

This information will be populated with the

detailed claim information below.

Enter the From Date of Service. Hit tab and enter the To Date of Service

Enter the Place of Service

Enter the appropriate procedure

code

Enter any appropriate Modifiers, if

needed

Enter the appropriate Diagnosis

cross reference

number, 1 2 3 or 4 with no comma

Enter the amount of units being billed for this procedure code

Enter the Usual and Customary Charge for this

procedure

When using NDC numbers type the quantity used in this field.

When billing with J codes, you must include the 11-digit NDC

number in this field.

Choose from the drop down the Unit of measure for the NDC code used.

This field is used by A-typical providers only. These are

providers who are not required to have an NPI number.

If the rendering and billing provider are the same, place the

cursor and the pointer in the rendering NPI field and double left click. The fields will populate for

you. If the contract code field applies to you,

choose from the drop down.

All providers who have an NPI number must also include either their

taxonomy number or the zip plus four.

Use these buttons to add additional lines of service or

to remove extra lines. To remove lines, highlight the line in blue then click the

remove button.

When you have typed in all lines of service, click on the Submit button to

process the claim. In a matter of seconds, you claim will process. You will see the claim status, an Internal Control Number (ICN) and the error

codes.

After hitting submit, the claim will pay or deny. If the claim shows a paid status, then at least one line of the claim paid. To verify if all lines on the claim paid, review each line detail or

review the claim under claim inquiry.

If no lines on the claim pay, the system will tell you that the claim is denied. You must review the denials listed

below to determine why the claim was denied. If you have miskeyed

information into the claim, which has made the claim deny, you can simply change the information on the claim form and hit the Resubmit button.

Denied Claim

Paid Claim

Medical Center Hospital

100123456A

Resolving Denials

To review claims submitted under your provider number, click on the

Claim Inquiry link.

012345678

2208000001234

2208000001234

To look up one claim, enter the ICN number. Other searches, such as, the client ID and dates will show all claims submitted for this provider, client and date of service. Various combinations of the search function will help narrow to more specific claims data. The website has six years of claims history. It is not recommended to hit

the search button without enter detailed criteria.

Once the claim/claims are found, click on the ICN to view the entire claim

2208000001234

If your claim is denied, it will list all the denials for each detail. For a more descriptive EOB remark code, click on the blue link. If the denial is

something that can be corrected, scroll back up to the claim form, change the information and click on resubmit. The system will resubmit

the claim.

If your claim requires a hard copy attachment, the website can be used to submit supporting documentation, TPL EOB, sterilization consent forms, proof of timely filing and other information pertinent to the processing of the claim.

If your claim requires a hard copy attachment, click on the down arrows to access the additional

fields needed to appropriately submit the attachment with the claim. If a claim requires an attachment: DO NOT click submit on the claim,

until all fields on the hard copy attachment screen are entered.

Submitting the Attachment, cont.

Enter an Attachment Control number: This should be a

random number that will be used to tie the attachment to the

claim.

How do you want to send the attachment?

What kind of documentation are you

sending? E.g. OZ-Support Document for

Claim

Give a short description of the

documentation being sent.

Submitting the Attachment, cont.

Once the hard copy attachment information is entered, click on the “Show” link, to print out the

HCA-13 form.

Oklahoma Health Care AuthorityElectronic Claim Paper Attachment Form

Cover Sheet

100123456A

Verify all information is correct and print.

Submitting the Attachment, cont.

After the HCA-13 is printed, you can now click on the Submit button.

NOTE: Claims that have a hard copy attachment will suspend until the

attachment is married to the claim.

Thank you for supporting the SoonerCare program.

For additional assistance please

contact:

OHCA Provider Services: 877-823-4529, Option 2 EDS Field Consultants: 800-522-0114, Option 1

or www.okhca.org