Denied Claims

Denied Claims (Oklahoma Health Care Authority Guides) Denied claims are claims that have been determined not covered by Oklahoma SoonerCare. These denials may be issued for various reasons including: non-covered services, inaccurate information submitted on the claim, member’s eligibility, or the provider’s contract information. Claims denied for non-covered service could be due to program restrictions Read More →

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Oklahoma Health Care Authority HIPAA Transactions Requirements The Health Insurance Portability and Accountability Act (HIPAA) is a national effort driven by the Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) geared toward administrative simplification and electronic submission standardization. The HIPAA influences the way protected health information (PHI) is Read More →

HIPAA training

How to deal with Paper Attachments to Electronic HIPAA Claims? OCHCA Explained An attachment cover sheet, form HCA-13, is available for every attachment to be submitted with electronic claims or electronic PA requests. HCA-13 allows claims or PA request submitters to continue billing their claims or PA requests electronically, even if an attachment needs to be sent Read More →

835 Remittance Advice

The 835 Remittance Advice  Transaction Set Guidelines (OCHCA) The EDI 835 transaction will only be used to send an Explanation of Benefits (EOB) RA. For SoonerCare, payment is separate from the EOB RA and will therefore not be affected by changes to how the provider receives payment – via paper or electronically. The 835 transaction will be Read More →