Oklahoma Complete Health Authorization Notification Reminder
Date: 12/20/24
Oklahoma Complete Health (OCH) will require providers to notify OCH within one (1) business day of member admissions effective January 1st, 2025.
As a courtesy reminder, please see the email notification and process below that was sent to providers on November 1st, 2024.
OCH Process for IP Admissions effective 1/1/2025
Provider facility is required to notify OCH within 1 business day of admission. OCH will administratively deny if this does not occur. Provider facility must send clinicals when notifying OCH of admission for OCH to make a determination within required timeframe (24 hours). OCH has 24 hours to make a determination from receipt of request. If OCH needs more documentation to make a determination, OCH can request needed additional documentation and extend the determination window.
· IP BH Acute Admissions: An extension is not granted if the necessary clinical documentation is not presented upon notification of admission and admission will be denied.
· IP Acute and Post Acute admissions: OCH may extend determination up to 72 hours of the initial request if additional documentation is needed to make a determination.
· IP BH Acute II/Psychiatric Residential Treatment Facility: OCH may extend determination up to 72 hours of initial request if additional documentation is needed to make a determination.
· TFC/ITFC: OCH may extend determination up to 14 days of initial request if additional documentation is needed to make a determination.
The admission will be denied if the additional requested documentation is not received within the referenced timeframe. At this point, the provider can appeal the decision or request a Peer-to-Peer Review.
Questions?
If you have any questions, please call Oklahoma Complete Health Provider Services at 1-833-752-1664 or visit the Find Your Provider Engagement Administrator tool to confirm the individual supporting your specialty and region. We encourage you stay up to date on Oklahoma Complete Health provider notices by reviewing and bookmarking Provider News.