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.
Go to: www.okhca.org
Log on ID is provider legacy
number
PIN information is listed on provider
welcome letter
To access the claim forms, click
on Claim Submission
The 1500 claim form, is called the
Professional
To begin, enter the
client ID and hit tab.
If your service requires a referral, enter the NPI of the Referring physician
Enter the primary
diagnosis code with no decimal
point. If additional
diagnosis codes are needed, hit
tab.
Dates will
populate as you fill out the claim
lines of service
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
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
Enter the appropriate procedure
code
Enter any appropriate Modifiers, if
needed
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
Enter the Usual and Customary Charge for this
procedure
When using NDC numbers type the quantity used in this field.
When billing with J codes, you must include the 11-digit NDC
number in this field.
Choose from the drop down the Unit of measure for the NDC code used.
This field is used by A-typical providers only. These are
providers who are not required to have an NPI number.
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.
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.
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.
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.
Denied Claim
Paid Claim
Medical Center Hospital
100123456A
Resolving Denials
To review claims submitted under your provider number, click on the
Claim Inquiry link.
012345678
2208000001234
2208000001234
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.
Once the claim/claims are found, click on the ICN to view the entire claim
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.
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.
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.
Submitting the Attachment, cont.
Once the hard copy attachment information is entered, click on the “Show” link, to print out the
HCA-13 form.
Oklahoma Health Care AuthorityElectronic Claim Paper Attachment Form
Cover Sheet
100123456A
Verify all information is correct and print.
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.
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