Oklahoma ranks among the best in the country for Medicaid eligibility and claims payment accuracy – Okemah News Leader

Oklahoma ranks among the many finest within the nation for Medicaid eligibility and declare cost accuracy

Oklahoma Metropolis, OK – The Oklahoma Well being Authority just lately accomplished its 2022 Cost Error Fee Measurement (PERM) evaluation with Facilities for Medicare & Medicaid Companies (CMS). PERM publishes an error charge that measures how precisely Medicaid packages course of claims and decide eligibility.

Oklahoma’s 2022 PERM error charge was 1.95%, the second lowest within the nation, and considerably under the nationwide common of 15.62%.

“OHCA prioritizes compliance and accountability to make sure that each greenback we spend goes to licensed providers for eligible members,” mentioned Kevin Corbett, OHCA CEO. “I’m happy with our group’s dedication to offering members with quick entry to high quality service whereas defending taxpayer funds.”

The PERM program makes use of a 17-state, three-year rotation cycle to measure improper funds and non-compliance. Every state is measured each three years. Oklahoma is a Cycle 1 state that was measured in 2022 and can be measured once more in 2025.

SoonerCare Eligibility Dedication

SoonerCare purposes are processed by verifying the applicant’s information via the varied eligibility necessities and data exchanges constructed into the digital software. The appliance course of makes an instantaneous determination on the applicant’s eligibility. SoonerCare processes 20,000 to 30,000 purposes monthly. Oklahoma was the one state to course of and course of 100% of purposes in lower than 24 hours within the first three months of 2022.

All through member eligibility, OHCA performs a system of checks, information exchanges and audits to make sure that the eligibility data reported is appropriate. The compliance error charge for 2022 was 1.95%.

SoonerCare Injury Cost

OHCA’s claims processing system features a complete set of rules used to make sure the accuracy of claims earlier than cost. OHCA makes use of management processes equivalent to pre-authorizations, suspended declare opinions, post-payment opinions, and cost accuracy measurement research to make sure the integrity and accuracy of claims. The declare error charge for 2022 was 0%, the bottom cost error charge in OHCA historical past.

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