MedicaidCoverageHigh impact
Provider Letter 2024-16: RE: Reimbursement for Provider Preventable Conditions Update
Oklahoma SoonerCare·OK·Provider Letter
Effective date
Sep 1, 2023
We identified it
Jun 20, 2026
Summary
OHCA will not reimburse providers for services treating provider preventable conditions (PPCs) including hospital-acquired conditions and wrong-site surgeries not present at admission. Providers must report all PPCs within 10 days and use specific billing procedures including POA indicators for DRG claims and HCPCS modifiers for outpatient claims.
Action Required
Immediately: Billing team must ensure all DRG hospital claims include Present on Admission (POA) indicators for all diagnosis codes or claims will be denied. For wrong-site surgeries, append applicable HCPCS modifiers to all related procedure lines. Providers must report all PPCs to OHCA within 10 days using the required report form. Update billing workflows to prevent submission of claims for hospital-acquired conditions and wrong-site procedures not present at admission.