What types of policy changes does Oklahoma SoonerCare issue?

Oklahoma SoonerCare regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Oklahoma SoonerCare update its policies?

Oklahoma SoonerCare typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Oklahoma SoonerCare policy changes are tracked here?

This page currently tracks 41 documented Oklahoma SoonerCare policy changes. New items are added as they are identified.

What should I do when Oklahoma SoonerCare changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Oklahoma SoonerCare Policy Changes & Prior Auth Updates

We track 41 documented policy changes from Oklahoma SoonerCare across OK. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Oklahoma SoonerCare notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Oklahoma SoonerCare updates automatically.

High impact
Provider Letter 2026-11: Re: Immediate Medicaid Coverage Change; Senate Bill 904 (2026)
Oklahoma SoonerCare·Effective Jun 4, 2026
Oklahoma Medicaid immediately prohibits coverage of surgical procedures and pharmaceuticals for gender transition under Senate Bill 904. Claims with gender dysphoria diagnoses will suspend for review, and prior authorization is now required for specific hormone therapies.
High impact
Provider Letter 2026-04: RE: D9248 update
Oklahoma SoonerCare·Effective Jan 1, 2026
Oklahoma Medicaid terminated dental code D9248 and replaced it with four new codes (D9244, D9245, D9246, D9247). Due to lower reimbursement rates for D9244 and D9245, Oklahoma will update these rates to match the previous D9248 rate of $135.67 by April 1, 2026.
High impact
Provider Letter 2025-18: Re: Executive Order 2025-16
Oklahoma SoonerCare·Effective Nov 21, 2025
Oklahoma Health Care Authority (OHCA) requires all providers to submit a signed attestation disclosing whether they engage in abortion-related activities as required by Executive Order 2025-16. The attestation must be completed and uploaded by November 21, 2025, or providers may face payment suspension, contract denial, or termination.
High impact
Provider Letter 2025-14: RE: DEN-6 Handicapping Labio-Lingual Deviation (HLD) Index Form Prior Authorization Process
Oklahoma SoonerCare·Effective Jun 1, 2025
Oklahoma Health Care Authority has updated the DEN-6 Handicapping Labio-Lingual Deviation Index Form used for orthodontic prior authorization. The revised form maintains the 30-point scoring system but includes clarified instructions and new 'automatic qualifier' conditions to better align with current dental standards.
High impact
Provider Letter 2025-02: RE: Pre-Pay Diagnosis Related Group Payments
Oklahoma SoonerCare·Effective Apr 1, 2025
Aetna Better Health of Oklahoma will implement pre-payment DRG validation starting April 1, 2025, requiring medical records to support all diagnosis and procedure codes submitted on claims. Claims with unsupported DRGs will be reimbursed at the calculated rate or denied based on Oklahoma state regulations.
High impact
Provider Letter 2025-06: Re: High Risk Screening Requirement Update for Applied Behavioral Analysis (ABA) Groups and Board-Certified Behavioral Analysts (BCBAs)
Oklahoma SoonerCare·Effective Apr 1, 2025
Starting April 1, 2025, ABA groups and BCBAs will be classified as high-risk providers requiring physical site visits for enrollment/reenrollment and fingerprint-based criminal background checks for new enrollments and ownership changes. Active contracts may be terminated without successful site visits.
High impact
Provider Letter 2025-09: RE: Aetna Beter Health of Oklahoma’s Implementation of PA Requirements for Specific Codes
Oklahoma SoonerCare·Effective Apr 1, 2025
Aetna Better Health of Oklahoma is implementing new prior authorization requirements for specific cardioversion procedures, surgical procedures, DME, and nerve injection codes effective April 1, 2025. These codes previously did not require prior authorization through OHCA but will now require prior auth for Aetna Better Health of Oklahoma Medicaid members.
High impact
Provider Letter 2024-28: RE: Prior Authoriza/on of Alymsys®, Avzivi® and Vegzelma® — effec/ve Jan. 13, 2025
Oklahoma SoonerCare·Effective Jan 13, 2025
Starting January 13, 2025, Oklahoma Medicaid (SoonerCare) will require prior authorization for three specific bevacizumab biosimilars: Alymsys, Avzivi, and Vegzelma. Three other bevacizumab products (Avastin, Mvasi, and Zirabev) will remain prior auth-free.
High impact
Provider Letter 2022-11: Re: PCMH Behavioral Health Screening Requirement
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Medicaid (SoonerCare) requires Patient-Centered Medical Home (PCMH) providers to conduct behavioral health screenings for all assigned members age 5 and above. Current compliance is below 35%, and providers must increase screening rates to meet contractual requirements.
High impact
Provider Letter 2025-19: RE: eQSuite® Training for Inpatient Behavioral Health Providers
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Health Care Authority is transitioning inpatient behavioral health prior authorization requests from fax submission to the electronic eQSuite portal system. Additionally, they are restricting reimbursement to only four specific revenue codes for inpatient psychiatric services.
High impact
Provider Letter 2025-21: RE: EVV Requirements for Reimbursement of Personal Care and Home Health Services
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Medicaid now requires Electronic Visit Verification (EVV) for all personal care and home health services to comply with federal mandate. Providers must onboard with designated EVV platforms (FiServ for SoonerCare or HHAeXchange for MCOs) to capture service details including provider, patient, location, dates, and times.
Medium impact
Provider Letter 2026-09: RE: Prior Authorization Nyvepria™ - Effective June 15, 2026
Oklahoma SoonerCare·Effective Jun 15, 2026
Oklahoma Medicaid will require prior authorization for Nyvepria™ (pegfilgrastim-apgf) effective June 15, 2026. Six other pegfilgrastim products remain preferred and do not require prior authorization, including Neulasta® and Fulphila®.
Medium impact
Provider Letter 2026-05: RE: Product-Based Prior Authorization for Hereditary Angioedema Medications Effective May 1, 2026
Oklahoma SoonerCare·Effective May 1, 2026
Oklahoma Medicaid (SoonerCare) is implementing new prior authorization requirements for all Hereditary Angioedema (HAE) medications effective May 1, 2026. All HAE prophylaxis and treatment medications will require prior authorization using Form PHARM-321, with tiered approval criteria requiring step therapy through lower-tier options first.
Medium impact
Provider Letter 2026-06: RE: Prior Authorization or Certain Intravenous and Subcutaneous Immunoglobulins Effective May 1, 2026
Oklahoma SoonerCare·Effective May 1, 2026
Oklahoma Medicaid will require prior authorization for 9 specific immunoglobulin products (including Alyglo, Asceniv, Bivigam, Cuvitru, Gammaplex, Hizentra, Octagam, Panzyga, and Xembify) starting May 1, 2026. Providers must use Form PHARM-322 and meet specific approval criteria including documentation of prior stabilization or clinical reasons why preferred products cannot be used.
Medium impact
Provider Letter 2026-01: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2025
Oklahoma SoonerCare·Effective Feb 28, 2026
Oklahoma providers who received $5+ million in Medicaid payments during FFY 2025 must complete and submit a Deficit Reduction Act compliance attestation form by February 28, 2026. This annual requirement confirms the provider has policies to educate staff about federal False Claims Act and whistleblower protections.
Medium impact
Provider Letter 2026-07: RE: Office/Outpatient Monthly Visit Limits
Oklahoma SoonerCare·Effective Feb 1, 2026
Oklahoma's SoonerCare (Medicaid) is removing the monthly limit of 4 physician office visits for adult members, effective February 1, 2026. Claims will no longer be denied solely for exceeding visit count thresholds, though all other requirements like medical necessity and prior authorization remain unchanged.
Medium impact
Provider Letter 2026-08: RE: Telehealth Originating Site Facility Fee
Oklahoma SoonerCare·Effective Feb 1, 2026
Oklahoma Medicaid (SoonerCare) will now reimburse facilities for hosting telehealth visits using new HCPCS code Q3014, effective February 1, 2026. This facility fee is separate from the professional service fee and can be billed once per day per member when specific requirements are met.
Medium impact
Provider Letter 2026-03: RE: Action Required: Amended Executive Order 2025-16
Oklahoma SoonerCare·Effective Jan 21, 2026
Oklahoma Health Care Authority has reinstated the provider attestation requirement under Executive Order 2025-16, effective immediately. Providers who haven't previously submitted an attestation must complete and submit the updated form by May 15, 2026.
Medium impact
Provider Letter 2026-02: RE: Important Update to Provider Contracting and Credentialing
Oklahoma SoonerCare·Effective Jan 7, 2026
Oklahoma Health Care Authority now allows providers to submit contract applications to OHCA and credentialing requests to SoonerSelect managed care plans simultaneously to streamline the credentialing process. During the credentialing period, claims will be reimbursed at 90% (non-participating rate) until credentialing is complete, then at 100% (participating rate).
Medium impact
Provider Letter 2025-22: RE: Prior Authorization Timeliness - Alignment with CMS Interoperability and Prior Authorization Rule (CMS-0057-F)
Oklahoma SoonerCare·Effective Jan 1, 2026
Oklahoma Medicaid (SoonerCare) is implementing new prior authorization processing timelines effective January 1, 2026, to comply with CMS regulations. Standard prior authorizations must be processed within 7 calendar days (with some exceptions allowing 14 or 21 days), while expedited/urgent prior authorizations must be processed within 72 hours.
Medium impact
Provider Letter 2025-23: RE: Prior Authorization of Photrexa®/Photrexa® Viscous Cross-Linking Kit - Effective January 1, 2026
Oklahoma SoonerCare·Effective Jan 1, 2026
Starting January 1, 2026, Oklahoma Medicaid will require prior authorization for Photrexa/Photrexa Viscous Cross-Linking Kit used to treat progressive keratoconus and corneal ectasia. The medication must be prescribed by trained optometrists or ophthalmologists and used with specific procedures and equipment.
Medium impact
Provider Letter 2025-20: RE: Pausing Executive Order 2025-16 Provider Attestation Requirements
Oklahoma SoonerCare·Effective Nov 12, 2025
Oklahoma Health Care Authority is pausing implementation of Executive Order 2025-16 provider attestation requirements until further notice. Provider renewals and applications can continue without the required attestations while OHCA seeks legal clarification.
Medium impact
Provider Letter 2025-12: RE: SoonerSelect Pharmacy Split Fill Logic for Certain Medications for Oklahoma Complete Health
Oklahoma SoonerCare·Effective May 1, 2025
Oklahoma Complete Health (Medicaid managed care) is implementing split fill logic for new-to-therapy pharmacy claims to reduce medication waste during the initial 90 days of treatment. This affects how prescriptions are dispensed for OCH members starting new medications.
Medium impact
Provider Letter 2025-13: RE: SoonerSelect Service Process Change to Remove GLP1 Medications From Drug Maintenance List for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program
Oklahoma SoonerCare·Effective May 1, 2025
Oklahoma Complete Health is removing GLP-1 medications (Trulicity, Byetta, Victoza) from their Drug Maintenance List, reducing maximum prescription supplies from 90 days to 30 days for SoonerSelect Medicaid members. This affects prescription dispensing limits for diabetes medications.
Medium impact
Provider Letter 2025-11: RE: Differentiation for D1354
Oklahoma SoonerCare·Effective Apr 10, 2025
Oklahoma Medicaid has clarified strict criteria for billing D1354 (caries arresting medicament) - it's only for silver diamine fluoride on active decay when patients can't receive typical restorative care, limited to once every 6 months with maximum 2 treatments per tooth lifetime. High concentration fluoride and preventive treatments should not be billed as D1354.
Medium impact
Provider Letter 2025-08: RE: Emergency Room (ER) Evaluation and Management (E/M) Leveling Program
Oklahoma SoonerCare·Effective Apr 1, 2025
Humana Healthy Horizons in Oklahoma (Medicaid managed care) will implement an ER E/M leveling program starting April 1, 2025, where they will downcode and pay at lower E/M levels if facility charges don't support the higher billed E/M codes based on defined criteria. This affects reimbursement for emergency department evaluation and management services for SoonerSelect Medicaid members.
Medium impact
Provider Letter 2025-10: RE: SoonerSelect Dental Changes to Claims Processing for Therapeutic Pulpotomies and Gross Pulpal Debridement for Liberty Dental Plan
Oklahoma SoonerCare·Effective Apr 1, 2025
Liberty Dental Plan will now recoup payment for therapeutic pulpotomies (D3220) and gross pulpal debridement (D3221) when the same provider subsequently performs endodontic therapy (D3310, D3320, D3330) on the same tooth. This affects SoonerSelect Medicaid dental claims processing in Oklahoma.
Medium impact
Provider Letter 2025-03: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2025
Oklahoma SoonerCare·Effective Feb 28, 2025
Healthcare providers who received at least $5 million in Oklahoma Medicaid payments during FFY 2025 must complete and submit an annual Deficit Reduction Act compliance attestation form. This attestation confirms the provider has appropriate policies and procedures in place to educate employees about federal and state fraud, waste, and abuse laws.
Medium impact
Provider Letter 2025-01: RE: Prior authorization of icatibant injection — effective Feb. 1, 2025
Oklahoma SoonerCare·Effective Feb 1, 2025
Starting February 1, 2025, Oklahoma Medicaid (SoonerCare) will require prior authorization for icatibant injections used to treat hereditary angioedema attacks. Patients currently on therapy will be approved for continuation, but new patients starting after January 1, 2025 need PA requests submitted to avoid treatment disruptions.
Medium impact
Provider Letter 2025-04: RE: SoonerSelect Prior Authorization Process for Tonsillectomies and/or Adenoidectomies for Members Over Age 12 for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program
Oklahoma SoonerCare·Effective Feb 1, 2025
Oklahoma Complete Health (Medicaid) now requires prior authorization using InterQual criteria for tonsillectomies and/or adenoidectomies performed on members over age 12, effective February 1, 2025. This adds a new prior auth requirement that did not previously exist for these procedures in this age group.
Medium impact
Provider Letter 2025-05: RE: SoonerSelect Cumulative Refill Too Soon Threshold for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program
Oklahoma SoonerCare·Effective Feb 1, 2025
Oklahoma Complete Health and Oklahoma Complete Health Children's Specialty Program have implemented new pharmacy refill threshold policies. In addition to the existing 80% refill threshold, they now use a 90% cumulative refill too soon threshold with 100-day claims history look-back for all medications except transplant drugs and ophthalmic drops.
Medium impact
Provider Letter 2024-26: RE: Value-Based Payments Programs
Oklahoma SoonerCare·Effective Jan 1, 2025
Oklahoma Medicaid is transitioning SoonerSelect providers from Patient-Centered Medical Home (PCMH) payments to Value-Based Payment (VBP) programs starting January 1, 2025. PCMH payments will continue through June 30, 2025, with VBP incentive payments beginning in Q3 2025.
Medium impact
Provider Letter 2024-29: RE: Professional Dental Consultations
Oklahoma SoonerCare·Effective Dec 20, 2024
Oklahoma Medicaid has clarified billing requirements for dental consultation code D9310, which requires a formal written consultation report to the referring provider. Consulting providers can alternatively bill D0140 for limited exams if they don't provide the required consultation documentation.
Medium impact
Provider Letter 2023-18: RE: Naloxone
Oklahoma SoonerCare·Identified Jun 20, 2026
SoonerCare (Oklahoma Medicaid) now covers naloxone products with no physician visit required. Pharmacists can prescribe and dispense naloxone under a standing order and receive reimbursement directly from Medicaid.
Medium impact
Provider Letter 2024-04: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2023
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma providers who received $5M+ in Medicaid payments during FFY 2023 must complete and submit an annual Deficit Reduction Act compliance attestation form. This confirms the practice has policies to educate employees about fraud prevention laws and whistleblower protections.
Medium impact
Provider Letter 2024-12: RE: Certified Registered Nurse Anesthetists Coding and Billing
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Medicaid (OHCA) has clarified billing requirements for Certified Registered Nurse Anesthetists (CRNAs) providing deep sedation anesthesia for dental procedures. CRNAs must bill using medical CPT/HCPCS codes rather than dental CDT codes, and must be listed as the rendering provider on claims.
Low impact
Provider Letter 2025-17: RE: Licensure Changes for Programs of All-Inclusive Care for the Elderly (PACE) Organizations
Oklahoma SoonerCare·Effective Sep 1, 2025
Oklahoma Health Care Authority made permanent the licensing changes for PACE organizations, allowing participants to use assisted living while enrolled and requiring PACE organizations to assess and address housing insecurity for participants. PACE organizations are no longer required to maintain adult daycare or home health certification when serving exclusively PACE participants.
Low impact
Provider Letter 2023-01: Re: OKCAPMAP
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Health Care Authority announced the launch of OKCAPMAP (Oklahoma Child and Adolescent Psychiatry and Mental Health Access Program), a new consultation service for primary care providers treating pediatric mental health patients. The program provides psychiatric consultation, education, and referral assistance but does not appear to introduce new billing requirements or code changes.
Low impact
Provider Letter 2024-09: RE: PDMP Compliance Survey
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Health Care Authority (OHCA) is requiring Medicaid prescribers to complete an anonymous survey about their compliance with checking the Oklahoma Prescription Drug Monitoring Program (PDMP) before prescribing controlled substances to Medicaid patients. This is for federal reporting requirements under the SUPPORT ACT.
Low impact
Provider Letter 2025-15: RE: PDMP Compliance Survey
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Health Care Authority is requiring all Medicaid prescribers to complete an anonymous survey about their PDMP (Prescription Drug Monitoring Program) compliance when prescribing controlled substances to Medicaid patients. This survey collects data required by federal law for CMS reporting to Congress.
Low impact
Provider Letter 2026-10: RE: PDMP Compliance Survey
Oklahoma SoonerCare·Identified Jun 20, 2026
Oklahoma Medicaid is requesting providers complete an anonymous survey about their PDMP (Prescription Drug Monitoring Program) usage when prescribing controlled substances to Medicaid patients between October 1, 2024 and September 30, 2025. This is for federal reporting requirements under the SUPPORT ACT.

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Provider Letter 2026-11: Re: Immediate Medicaid Coverage Change; Senate Bill 904 (2026)

Provider Letter 2026-04: RE: D9248 update

Provider Letter 2025-18: Re: Executive Order 2025-16

Provider Letter 2025-14: RE: DEN-6 Handicapping Labio-Lingual Deviation (HLD) Index Form Prior Authorization Process

Provider Letter 2025-02: RE: Pre-Pay Diagnosis Related Group Payments

Provider Letter 2025-06: Re: High Risk Screening Requirement Update for Applied Behavioral Analysis (ABA) Groups and Board-Certified Behavioral Analysts (BCBAs)

Provider Letter 2025-09: RE: Aetna Beter Health of Oklahoma’s Implementation of PA Requirements for Specific Codes

Provider Letter 2024-28: RE: Prior Authoriza/on of Alymsys®, Avzivi® and Vegzelma® — effec/ve Jan. 13, 2025

Provider Letter 2022-11: Re: PCMH Behavioral Health Screening Requirement

Provider Letter 2025-19: RE: eQSuite® Training for Inpatient Behavioral Health Providers

Provider Letter 2025-21: RE: EVV Requirements for Reimbursement of Personal Care and Home Health Services

Provider Letter 2026-09: RE: Prior Authorization Nyvepria™ - Effective June 15, 2026

Provider Letter 2026-05: RE: Product-Based Prior Authorization for Hereditary Angioedema Medications Effective May 1, 2026

Provider Letter 2026-06: RE: Prior Authorization or Certain Intravenous and Subcutaneous Immunoglobulins Effective May 1, 2026

Provider Letter 2026-01: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2025

Provider Letter 2026-07: RE: Office/Outpatient Monthly Visit Limits

Provider Letter 2026-08: RE: Telehealth Originating Site Facility Fee

Provider Letter 2026-03: RE: Action Required: Amended Executive Order 2025-16

Provider Letter 2026-02: RE: Important Update to Provider Contracting and Credentialing

Provider Letter 2025-22: RE: Prior Authorization Timeliness - Alignment with CMS Interoperability and Prior Authorization Rule (CMS-0057-F)

Provider Letter 2025-23: RE: Prior Authorization of Photrexa®/Photrexa® Viscous Cross-Linking Kit - Effective January 1, 2026

Provider Letter 2025-20: RE: Pausing Executive Order 2025-16 Provider Attestation Requirements

Provider Letter 2025-12: RE: SoonerSelect Pharmacy Split Fill Logic for Certain Medications for Oklahoma Complete Health

Provider Letter 2025-13: RE: SoonerSelect Service Process Change to Remove GLP1 Medications From Drug Maintenance List for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program

Provider Letter 2025-11: RE: Differentiation for D1354

Provider Letter 2025-08: RE: Emergency Room (ER) Evaluation and Management (E/M) Leveling Program

Provider Letter 2025-10: RE: SoonerSelect Dental Changes to Claims Processing for Therapeutic Pulpotomies and Gross Pulpal Debridement for Liberty Dental Plan

Provider Letter 2025-03: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2025

Provider Letter 2025-01: RE: Prior authorization of icatibant injection — effective Feb. 1, 2025

Provider Letter 2025-04: RE: SoonerSelect Prior Authorization Process for Tonsillectomies and/or Adenoidectomies for Members Over Age 12 for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program

Provider Letter 2025-05: RE: SoonerSelect Cumulative Refill Too Soon Threshold for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program

Provider Letter 2024-26: RE: Value-Based Payments Programs

Provider Letter 2024-29: RE: Professional Dental Consultations

Provider Letter 2023-18: RE: Naloxone

Provider Letter 2024-04: RE: Yearly Compliance with the Deficit Reduction Act of 2005 – FFY 2023

Provider Letter 2024-12: RE: Certified Registered Nurse Anesthetists Coding and Billing

Provider Letter 2025-17: RE: Licensure Changes for Programs of All-Inclusive Care for the Elderly (PACE) Organizations

Provider Letter 2023-01: Re: OKCAPMAP

Provider Letter 2024-09: RE: PDMP Compliance Survey

Provider Letter 2025-15: RE: PDMP Compliance Survey

Provider Letter 2026-10: RE: PDMP Compliance Survey