Oklahoma Complete Health Medicaid Prior Authorization Requirements Changes Effective September 1, 2024
Date: 07/31/24
Oklahoma City, OK
Oklahoma Complete Health requires prior authorization as a condition of payment for many services. This notice contains information regarding such prior authorization requirements and is applicable to all Medicaid products offered by Oklahoma Complete Health.
The following services will require a prior authorization effective September 1, 2024:
H2034- Alcohol and/or Drug Abuse Halfway House Services, per Diem.
H0010- Alcohol and/or DRG Service; Sub-Acute Detox- IP
H0018- Behavioral Health; Short-Term Res Per Diem (i.e. group home).
H0019- Behavioral Health; Long-Term Res Per Diem
Oklahoma Complete Health is committed to delivering cost-effective, quality care to our members. This requires us to ensure that our members only receive treatments that are medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.
Please verify every member’s eligibility and benefits prior to rendering services to them. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. Non-Par Providers and facilities require authorization for all services except where indicated.
The codes listed in this document represent the national, standard code sets. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement. Please refer to your contract with Oklahoma Complete Health to determine all contracted/covered codes for each membership group. Please refer to the Medicaid Fee Schedule and the Billing and Procedure Coding Guide for a list of approved modifier codes.
For a complete list of CPT/HCPCS codes, please use the Pre-Auth Check Tool.
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.