Earn an Enhanced Payment for SoonerSelect Social Drivers of Health (SDoH) Screenings
Date: 01/16/25
Earn an Enhanced Payment for SoonerSelect Social Drivers of Health (SDoH) Screenings
Understanding and addressing social drivers of health (SDoH) is critical for improving patient outcomes and reducing health disparities. These factors include access to food, housing, transportation, paying utility bills and interpersonal safety. By screening and identifying these factors, healthcare providers can connect patients with resources to address barriers and improve overall well-being.
Oklahoma Complete Health establishes the Social Drivers of Health (SDoH) Enhanced Payment Program to improve the quality of care, increase preventative and screening services and promote Oklahoma Complete Health (OCH) member engagement. This program will provide a payment incentive to SoonerSelect Primary Care Providers (PCPs) who proactively screen OCH members for their SDoH needs and connect them to needed resources.
Beginning January 1, PCPs will be able to submit enhanced payment claims for ICD-10-CM Z codes. Eligible target measures and enhanced payment amounts:
o $2 for SDoH screening performed and negative.
o $5 for SDoH screening performed and positive and provision of recommendations.
Enhanced Payment Program Details
PCPs will choose a nationally recognized SDoH screening tool to screen eligible patients. Patients must be Oklahoma Complete Health members who have not been screened more than twice in the same calendar year.
Payments will be linked to specific claim codes and will be paid as claims are submitted. PCPs must use the appropriate codes to document the screening results in the patient records to file claims.
· Document any identified patient needs using the appropriate Z codes
· Document the results of the SDoH screening with the appropriate G codes
o G9920: Screening performed and negative (no SDOH needs identified)
o G9919: Screening performed and positive and provision of recommendations
If relevant, document the appropriate CPT code to improve alignment with SDoH data elements:
· 96160: Food Insecurity
· 96156: Housing Insecurity
· 96161: Transportation Insecurity
Z Codes represent factors that influence health status and any contact with health services that may be recorded as diagnoses.
To learn more about benefits and barriers to utilizing Z Codes, we encourage providers to reference this Quick Guide to SDOH ICD-10 Codes (PDF).[RO1]
Our Enhanced Payment Program is in addition to the compensation arrangement set forth in your participation agreement in our provider network.
Questions?
If you have any questions, please call Oklahoma Complete Health Provider Relations at 1-833-752-1664.
Our Provider Engagement staff are also here to help answer questions, visit https://www.oklahomacompletehealth.com/providers.html to connect to the Provider Portal or locate your Provider Engagement Representative.