MedicaidCoverageMedium impact
Provider Letter 2026-07: RE: Office/Outpatient Monthly Visit Limits
Oklahoma SoonerCare·OK·Provider Letter
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
Oklahoma's SoonerCare (Medicaid) is removing the monthly limit of 4 physician office visits for adult members, effective February 1, 2026. Claims will no longer be denied solely for exceeding visit count thresholds, though all other requirements like medical necessity and prior authorization remain unchanged.
Action Required
Before February 1, 2026: Billing team should monitor for system updates from Oklahoma Medicaid and be prepared to resubmit any claims previously denied for exceeding monthly visit limits once the policy takes effect. Review current denied claims for visit limit rejections that may be eligible for resubmission after the effective date.