Transcript Welcome to the Oklahoma SoonerCare Program

Welcome to the
Oklahoma SoonerCare
Program
www.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
Dates
will
populate
as you fill
out the
claim
lines of
service
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.
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 billing with J codes, you
must include the 11-digit NDC
number in this field.
When using NDC numbers type
the quantity used in this field.
Choose from the drop down the
Unit of measure for the NDC code
used.
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.
This field is used by A-typical
providers only. These are
providers who are not required
to have an NPI number.
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.
Paid Claim
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.
Denied Claim
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.
Resolving Denials
Medical Center Hospital
100123456A
To review claims submitted under
your provider number, click on the
Claim Inquiry link.
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.
2208000001234
2208000001234 012345678
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. OZSupport 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 Authority
Electronic 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