SECTION 317:35-15-14. Billing procedures for personal care

  Billing procedures for personal care services are contained in the Oklahoma Medicaid Management Information Systems (OKMMIS) Billing and Procedure Manual. Questions regarding billing procedures that cannot be resolved through a study of the manual are referred to the Oklahoma Health Care Authority (OHCA). Contractors for Personal Care bill on CMS-1500 claim form. OHCA provides instructions to an Individual personal care assistant (IPCA) contracted provider for completion of the claim at the time of the contractor orientation. The contracted provider submits a claim for each member. The contracted provider prepares claims for services provided and submits the claims to the fiscal agent responsible for ensuring claims were properly completed. All personal care contractors must have a unique provider number. New contracted providers are mailed the provider number after they are placed on the claims processing contractor's provider file. All services provided in the service recipients home, member's home including Personal Care and Nursing must be documented through the Electronic Visit Verification (EVV) system. Additionally, work completed in the provider's office is documented in the EVV system. The EVV system provides alternate backup solutions if the automated system is unavailable; however, in the event of an EVV system failure, the provider documents time in accordance with internal policy and procedures backup plan. This documentation is sufficient to account for both in-home and in-office services. The provider agency's backup procedures are only permitted when the EVV system is unavailable.

[Source: Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg 1802, eff 5-27-97; Amended at 15 Ok Reg 25, eff 9-18-97 (emergency); Amended at 15 Ok Reg 1554, eff 5-11-98; Amended at 20 Ok Reg 1958, eff 6-26-03; Amended at 26 Ok Reg 558, eff 2-1-09 (emergency); Amended at 26 Ok Reg 2149, eff 6-25-09; Amended at 32 Ok Reg 1142, eff 8-27-15; Amended at 34 Ok Reg 726, eff 9-1-17]