Welcome to the Oklahoma SoonerCare Program www'okhca'org

1
Welcome to the Oklahoma SoonerCare
Programwww.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.

2
Go to www.okhca.org
3
Log on ID is provider legacy number
PIN information is listed on provider welcome
letter
4
To access the claim forms, click on Claim
Submission
5
The 1500 claim form, is called the Professional
6
Dates will populate as you fill out the claim
lines of service
Enter the primary diagnosis code with no decimal
point. If additional diagnosis codes are needed,
hit tab.
To begin, enter the client ID and hit tab.
If your service requires a referral, enter the
NPI of the Referring physician
7
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
8
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
9
Enter the appropriate procedure code
Enter any appropriate Modifiers, if needed
10
Enter the Usual and Customary Charge for this
procedure
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
11
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.
12
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.
13
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.
14
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.
15
Resolving Denials
Medical Center Hospital
100123456A
To review claims submitted under your provider
number, click on the Claim Inquiry link.
16
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
012345678
2208000001234
Once the claim/claims are found, click on the ICN
to view the entire claim
17
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.
18

• 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.
19
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.
OZ-Support Document for Claim
Give a short description of the documentation
being sent.
20
Submitting the Attachment, cont.
Once the hard copy attachment information is
entered, click on the Show link, to print out
the HCA-13 form.
21
Oklahoma Health Care Authority Electronic Claim
Paper Attachment Form Cover Sheet
Verify all information is correct and print.
100123456A
22
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.
23
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