July 14, 2010
The Oklahoma Health Care (OHCA) Authority Board of Directors met on June 10th and approved proposed Incontinence Supply Rate Changes for the ADvantage Program and thereby established fixed and uniform rates for incontinence supplies, effective Sept. 1, 2010.
Detailed information regarding the new rates may be reviewed at:
http://okhca.org/WorkArea/DownloadAsset.aspx?id=11806 (Link opens in new window)
To comply with these new rules, only the T-Codes identified under this rate change are to be used for authorizations of Incontinence supplies and the use of Codes A4520 and A4554 are being discontinued. In order to accommodate this significant change to member service plan records, the following multi-step approach will occur.
- ADvantage DME providers will receive a communication requesting that they update current incontinence supply service lines that use A-Codes with a matching new service T-code for the item. A spreadsheet with individual member information will be provided to be completed and returned to the AAU.
- Case Management agencies will receive a communication describing the process to be taken for reassessment and new member service plans.
- The AAU will administratively adjust existing service plans by ending the existing Authorization and replacing it with the correct T-Code information (A-Code replacements and T-Code adjustments to new system rate). Both the Case Management and the DME provider will receive the Adv6g listing the new service code, number of units, rate, and prior authorization.
PLEASE NOTE: We respectfully request that Case Managers NOT send in addendums to existing plans to change the procedure code and rate.
If you have any questions or concerns regarding the information provided above, please feel free to contact us via email at Provider Questions.