For purposes of SoonerCare reimbursement, telemedicine is the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment that occur in real time and when the member is actively participating during the transmission.
SoonerCare (Oklahoma’s Medicaid program) reimburses for live video when the GT modifier is billed and the proper documentation to include services rendered, location and services provided via telemedicine is maintained.
OHCA has discretion and final authority to approve or deny telehealth services based on agency and/or SoonerCare members’ needs. See Medicaid Telehealth webpage for full list of eligible CPT Codes for Medical and Behavioral Health Services. Services provided by telehealth must be billed with the appropriate modifier.
To participate, a provider must: Be contracted with SoonerCare and appropriately licensed, bill for services using the appropriate modifier (GT), and maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telemedicine.
The medical or behavioral health related service must be provided at an appropriate site for the delivery of telehealth services. An appropriate telehealth site is one that has the proper security measures in place; the appropriate administrative, physical and technical safeguards should be in place that ensures the confidentiality, integrity and security of electronic protected health information. The location of the room for the encounter at both ends should ensure comfort, privacy and confidentiality.
A patient may receive telehealth services outside of Oklahoma when medically necessary. Out of state providers must comply with all laws and regulations of the provider’s location, including health care and telemedicine requirements.
"Telemedicine means the practice of health care delivery, diagnosis, consultation, treatment, including but not limited to, the treatment and prevention of strokes, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.”
For services determined to be appropriately provided by means of telemedicine, health care insurer programs, workers’ compensation programs and state Medicaid managed care contracts shall not require person-to-person contact between a health care practitioner and patient.
Telemedicine means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store-and-forward technologies, between a patient and a physician with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit.
A physician-patient relationship can be established, provided that a physician: Holds a license to practice medicine, confirms the patient's identity and provides the patient with the treating physician's identity and professional credentials.
Our telemedicine services can be applied to big cities as well as rural locations. We contract with the highest quality health professionals and partner with hospitals, clinics, and other healthcare facilities throughout the Nation.