Providers press OHCA on credentialing, PBMs, payments and transport during Sooner Select Q&A

Providers at the town hall raised detailed implementation questions about how Sooner Select would work in practice and OHCA officials answered with operational commitments and follow-up items.

Casey Blackwell, a pharmacist who represents about 300 community pharmacies through AlignRx, asked whether copays and pharmacy payments would be standardized across plans and whether pharmacies would need to contract with plan PBMs. OHCA’s Traylor Raines said copays will remain at state-set levels and plans may choose to waive copays in some cases but may not increase them above state limits; OHCA also said that PBM choice is at the contracting plan’s discretion and OHCA would follow up with specifics about pharmacies’ contracting needs.

Multiple providers expressed concern about administrative burden from transitioning to several plan partners. Raines reiterated that providers will maintain OHCA enrollment and that the single provider portal should show the plan a member is assigned to so clinics will not need to guess which plan to bill. OHCA said plans have agreed to a centralized credentialing verification organization to reduce duplicate work, though credentialing timelines could vary among plans and in some cases may be longer than the OHCA’s historical processing time.

Providers asked about continuity for prior authorizations and authorizations already in place; Raines said there will be a 90‑day continuity period during which existing authorizations will transition to plans before plans implement their own processes.

On nonemergency transport, Sonia Coleman of the Emergency Medical Services Authority asked whether plans would use multiple vendors and create administrative burden for ambulance providers. OHCA said plans will administer nonemergency transport for members in their covered population; vendors may differ by plan and OHCA will oversee compliance and work with plans to reduce unnecessary provider burdens.

Raines also discussed health information exchange work, noting providers and members may enroll in the HIE or request an exemption; OHCA said it expects plans to use HIE data where available and plans will combine it with claims and encounter data.

OHCA encouraged providers to talk directly with plan representatives after the town hall and offered a follow-up Q&A document and a Sooner Select webpage for ongoing questions.

Next steps OHCA committed to: publish PBM and pharmacy contracting details, clarify credentialing timelines, share specifics of plan vendor networks for transportation and DME, and update the provider community via the Sooner Select site and Q&A document.