‘Needs to be discussed’: Health care providers having problems with SoonerSelect launch
OKLAHOMA CITY (KFOR) – Some Oklahoma health care providers tell News 4 they’re experiencing challenges with the SoonerSelect rollout, despite reassurance from the Oklahoma Health Care Authority (OHCA) that things are running smoothly.
SoonerSelect launched Monday, a new privatized approach for more than a million vulnerable Oklahomans who rely on Medicaid.
OKCPS enrollment for 2024-25 school year now open
The three programs Oklahomans qualifying either chose or were assigned to are the following:
Aetna Better Health of Oklahoma: 844-365-4385, AetnaBetterHealth.com/Oklahoma
Humana Healthy Horizons: 855-223-9868, Humana.com/Medicaid/Oklahoma
Oklahoma Complete Health: 833-752-1664, OklahomaCompleteHealth.com
“I think, in theory, it is probably a good idea and I think all around it will benefit patients and providers if it’s working the way it’s supposed to work,” said LaCresha Harris, R.N. Clinical Manager at First Choice Pediatrics in Edmond.
Harris said since the rollout of the program Monday her clinic has seen a reassignment of most of its patients to different health care providers.
“They’re receiving new cards in the mail with a new pediatrician,” said Harris.
She said her clinic typically relies on capitation payments, payments made in advance based on its number of patients, to get by; but under its current list would only receive 10% of that usual payment.
“Our monthly payments are right around the $3,000 mark, so it’s a huge discrepancy that we’re talking about,” said Harris.
News 4 reached out to OHCA for clarification on Harris’ experience.
A spokesperson said the authority is working with the three contracted entities to make sure all PCP information and provider directories are up to date.
It said incentive payments will be made on April 17 and will reflect April 1 data. It said providers were sent a notice of the payment schedule last week.
Harris told News 4 she’s unconvinced the program was ready to go regardless.
“I don’t think that we were quite ready to roll it out from the state level, especially three days ago,” said Harris. “And we are seeing evidence to that, that supports that. It’s not beneficial to the providers at this time.”
Josh McDowell, a licensed professional counselor at Scissortail Therapies in Moore, told News 4 Thursday he’s also been frustrated with the rollout.
“I have to choose between helping out the Medicaid population and working with the people that really need it or doing what my family needs,” said McDowell.
McDowell said he feels as if some providers have been left in the dark recording the appropriate ways to bill for their services and that, despite a promised 90 day continuity period to make sure providers are paid, he’s worried about the future.
“Even just the most basic information of how we have to bill,” said McDowell. “There’s still parts in the [provider] manuals that aren’t ironed out yet and that don’t exactly make sense or they contradict each other.”
Oklahoma girl scouts invited to Chickasaw Bricktown Ballpark for a night of baseball
A spokesperson for OHCA told News 4 that if providers need assistance or are confused about a coverage or process than can contact OHCA at 800-522-0114 or SoonerSelect@okhca.org.
The OHCA also provided the following statement in hopes of clearing up other concerns:
OHCA has been working closely with providers and all three SoonerSelect contracted entities for several months conducting multiple provider education and knowing that providers and members may face questions as SoonerSelect rolls out. OHCA’s is actively engaging with the CEs to guarantee our providers and members receive the support they need and further educate providers on new processes. There is a 90-day continuity of care period where CEs must honor all existing authorizations, regardless of contract status with the plans, to allow providers time to transition to a new system and to ensure members receive needed care. OHCA will hold each CE accountable to ensure compliance with state, federal, and contractual obligations, prioritizing the well-being of our members and providers.
Oklahoma Health Care Authority
For the latest news, weather, sports, and streaming video, head to KFOR.com Oklahoma City.
