August Industry Notes: Medicaid, Worker’s Comp, and Payer Updates

Kentucky Medicaid Announcement 

On July 29, 2025, the Cabinet for Health and Family Services was notified of a technical issue with a state software program that will result in delayed payments to Medicaid providers in Kentucky. We are working with the vendor to get payments to providers on Friday, August 1, 2025. We apologize for any inconvenience.

Kentucky Department for Medicaid Services 

Oklahoma Sooner Care 

To align with EDI and SoonerSelect standards, OHCA has added “9999” to the ZIP+4 field for all providers where the ZIP+4 was missing. No changes were made to provider files if a ZIP+4 code was already on file. If OHCA made changes to your file, please include “9999” on the ZIP code for the billing, rendering and/or ordering provider(s) as needed when submitting claims to OHCA or our SoonerSelect partners. ZIP+4 codes must be unique to each provider service location. If claims are rejected due to ZIP code issues or if you believe your location may have a duplicate “9999” value, please check your provider portal or the OHCA Provider Directory for your assigned ZIP+4. You may also contact Provider Enrollment to confirm the correct ZIP+4 on file or request an update. 

Oklahoma Enacts Legislation Significantly Modernizing NP and PA Practice 

In Oklahoma, the supervision requirements for Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) can change based on legislation. Here’s what is generally accurate as of recent years: 

Physician Assistants (PAs) in Oklahoma: 

• As of recent legislation (HB 2874, passed in 2022), PAs with more than 4,000 hours (~2 years full-time) of supervised practice may apply to practice with reduced or no supervision, depending on the setting. 

• After that threshold, the PA can apply for independent practice in collaboration rather than direct supervision. 

Advanced Practice Registered Nurses (APRNs): 

• As of SB 458 (2023), APRNs in Oklahoma may practice independently (without physician supervision) if they: 

• Have 3+ years (6,240 hours) of clinical practice under a physician, 

• Are practicing in primary care settings, 

• Meet other criteria established by the Oklahoma Board of Nursing. 

This change allows qualifying APRNs to practice without a supervising physician, consistent with what you mentioned. 

Source: Source: https://s3.amazonaws.com/fn-document-service/file-by-sha384/76c888710777a3b46559fa15f549dcb96ebfccfa776c4331ab0253aa9043288c35f727a37265616524f6991825d87af8
https://s3.amazonaws.com/fn-document-service/file-by-sha384/76630d7ef88c6416708b2ae849b7e81e0842e2ccba758117b0d51c73d5be52a9bbe24dcaae92ad9094ed03bff507f695
https://oklahoma.gov/nursing/practice.
https://www.aapa.org/news-central/2025/06/oklahoma-enacts-legislation-significantly-modernizing-pa-practice/ 

Worker’s Compensation Update 

Effective August 9, 2025, the Office of Workers’ Compensation Programs (OWCP) will require group practices to include the servicing or rendering provider National Provider Identifier (NPI) when billing a professional claim. In addition, group practices must ensure the submitted servicing or rendering NPI is associated with an active servicing provider in the OWCP provider file. 

Billing 

Please follow the steps below to ensure the servicing NPI is submitted on the bill. 

Please note that this requirement is not applicable to providers enrolled as individuals, facilities, or non-medical providers. This requirement is also not applicable to institutional or dental bills. 

• Online (Direct Data Entry DDE): Servicing provider information can be entered on professional bills as the rendering provider in the Provider Information section or at the service line. Refer to the Enter Bills Online Tutorial for instructions and examples. 

• Electronic Data Interchange (EDI): Servicing provider information is submitted in the Professional claim type Appendix A Loop 2310B for Rendering Provider information. Refer to the 837 Companion Guide for more details. 

• Paper: Servicing provider information is entered in Box 24J of the service line on the OWCP 1500 Professional bill form. Refer to the Health Insurance Claim Form (OWCP-1500) instructions for more information. 

Provider Enrollment 

Professional bills from group practice providers received on or after August 9, 2025, will be denied if submitted without the servicing or rendering NPI, or if the submitted servicing or rendering NPI is not active in the group provider file. 

Providers can review and, if needed, update the servicing provider information through the Workers’ Compensation Medical Bill Processing (WCMBP) portal https://owcpmed.dol.gov/, or by paper on the Provider Enrollment Application (OWCP-1168) Form. 

• Online: Providers are encouraged to use the WCMBP portal OWCP Medical Bill Processing Portal (https://owcpmed.dol.gov) to review and update servicing provider NPI information. In addition, providers can review and confirm existing provider record information such as license information, contact information, and payment details. Instructions are available at: Updating Provider Information Resource Guide.
  Registration is required for WCMBP portal access. Providers can refer to the Provider Registration for Online Access (Updated 02/05/25) quick reference guide for more information. 

• Mail: Providers can mail the updated Provider Enrollment Application (OWCP-1168) to the following address:
  Provider Enrollment 
  Department of Labor – OWCP 
  P. O. Box 8312 
  London, KY 40742-8312  

• Fax: Updated Provider Enrollment Application (OWCP-1168) information may also be sent by fax to 888-444-5335. 

Blue Card Out of Area Member Claims 

The summer vacation season may be ending for some, but holiday visits and winter escape planning are just beginning for others. Through our BlueCard program, many members with Blue Cross and Blue Shield can take their coverage with them when they travel.  

Here’s how the program works: The program offers convenience for members, without causing more work for you. 

• As a participating provider with Blue Cross and Blue Shield of Illinois, you may see members with BCBS from other states. 
• BCBSIL is the host plan for these “guest” members while they’re traveling or living away from their home plans. 
• When you welcome these out-of-area members as patients, BCBSIL welcomes your BlueCard claims for their care. 

BlueCard claim filing checklist: Follow these steps when seeing members from out-of-area plans. 

• Ask members for their current ID card. Some out-of-area members may have a suitcase logo on their ID card. Refer to the How to Identify Members section of the BlueCard program manual for more information. Also ask for a photo ID to confirm the member’s identity.  
• When recording the member’s ID number, include the three-character prefix. This prefix indicates the member’s group information and helps to confirm BlueCard program participation.  
• Check eligibility and benefits. For faster results, check membership and coverage details electronically through Availity® Essentials, or your preferred web vendor. If you don’t have online access, call the BlueCard Eligibility line at 800-676-2583. This step also helps you confirm prior authorization requirements. 
• If prior authorization is required, you can use Availity Authorizations to initiate an electronic request (278 transaction). If the patient is a member with BCBS in another state, you’ll be routed to that payer’s platform to complete the request as part of the electronic provider access process. 
• Submit BlueCard claims electronically to BCBSIL. Learn more about claim submission. Don’t submit duplicate claims.  
• Check claim status online. Check the status of the original claim via Availity or your preferred vendor portal. Use the Availity Claim Status tool for detailed results.