payers overview

Payers Overview

Payers Overview

Payers in ChartCaddy are categorized into four different types:
  1. Cash - There is only one cash payer and it is called SELF PAY. Claim items are generated for cash payers but not submitted electronically.
  2. Limited - Claim items are generated for limited payers but not submitted electronically. These payers are usually custom contracts with specific entities that are invoiced.
  3. OKHCA - Claim items are generated for OKHCA payers and submitted electronically directly to the Oklahoma Health Care Authority.
  4. Clearinghouse - Claim items are generated for clearinghouse payers and submitted electronically to whatever clearinghouse is configured for your organization. Currently AdminisTEP, Availity, and Office Ally are supported.

MCO Payers

There are three clearinghouse payers that are also contracted with the OKHCA to process claims for Oklahoma Medicaid clients. The three MCO payers require prior authorization for very few OPBH services. All three should have the same requirements for that, and one of them provides an online tool to look up services to see if prior authorization is required: https://www.aetnabetterhealth.com/oklahoma/providers/prior-authorization.html
  1. Aetna Better Health Oklahoma
    1. ChartCaddy Name: OK Aetna
    2. Support Website: https://www.echohealthinc.com
    3. Contact: Rita Hanson, hansonr@aetna.com
  2. Humana Healthy Horizons Oklahoma
    1. ChartCaddy Name: OK Humana
    2. Support Website: https://www.availity.com
    3. Contact: Kasi Hilley:  KHilley@humana.com
  3. Oklahoma Complete Health
    1. ChartCaddy Name: OK Complete
    2. Support Website: https://www.PaySpanHealth.com
    3. Contact: Yvonne Harnden, Yvonne.Harnden@OklahomaCompleteHealth.com