Providers and Partners

American Health Advantage of Oklahoma provides Medicare Part D prescription drug coverage through our partner MedImpact. MedImpact is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

Part B Drugs, drugs that are not usually self-administered and are administered as part of a physician or outpatient service, click here.

Medicare Part B covers drugs, such as the following:

• Drugs requiring an infusion pump;
• Immunosuppressive drugs for people who had a Medicare covered transplant;
• Hemophilia clotting factors;
• Antigens;
• Intravenous immune globulin provided in the home;
• Erythropoietin for people with end stage renal disease (ESRD);
• Parenteral nutrition for people with a permanent dysfunction of their digestive tract.
• Regional differences in Part B drug coverage policies can occur in the absence of a national coverage decision.

Part D Drugs, Drugs available only by prescription, approved by the FDA, and used for a medically accepted indication which are not covered under Part B (or Part A), see below:

For Prescribers:

• Access Formulary and Prior Authorization Forms at https://elixirsolutions.promptpa.com
  • Select “Prescribers” and click on “Prior Authorization”
  • Enter your NPI number and State to access the prescriber portal
• MedImpact  Pharmacy Helpdesk
  • Phone number: 1-833-478-6370
  • TTY phone number: 711
• Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

For Pharmacies:

• Access payer sheets and other information at https://elixirsolutions.promptpa.com
  • Select “Pharmacies” and click “Pharmacies Login”
  • Enter your NPI number and NCPDP number to access the pharmacy portal
• MedImpact  Pharmacy Helpdesk
  • Phone number: 1-833-478-6370
  • TTY phone number: 711
• Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

At American Health Advantage of Oklahoma, we specialize in improving health care and advancing a truly unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our Providers. The American Health Advantage of Oklahoma Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing facilities or individuals living in the community or a contracted assisted living facility (ALF) but require an institutional level of care (LOC) As we help extend your care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral health care needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short-term and long-term care goals. Our model organizes best practices and industry innovations including:

• The Advanced Nurse Practitioner (ANP) and primary care physician (PCP)/NFist (a PCP specializing in the care of nursing home patients) care team providing onsite, facility-based PCP support;
• A risk-assessment tool designed for a senior, nursing facility patient population;
• A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
• A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination; and
• Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our Providers are properly trained and informed about the American Health Advantage of Oklahoma Model of Care. Our top priority is making sure all of the providers in the American Health Advantage of Oklahoma network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve American Health Advantage of Oklahoma Members, your patients.

• Click on each ‘+’ below to review material.
• Complete Attestation

American Health Advantage of Oklahoma contracts with physicians, facilities and other allied providers to ensure we have an adequate Provider network which is essential for the delivery of health care services to our members. All Providers must be credentialed before they can be added to our network as a participating Provider. Why Partner with American Health Advantage of Oklahoma:

• From the beginning, physicians discover that American Health Advantage of Oklahoma isn’t just another Medicare Advantage health plan.
• We have a different philosophy, attitude and approach to caring for our Members.
• Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members/your patients’ quality of life.
• We strive to provide our Members exceptional benefits and an abundance of attention.
• And we believe American Health Advantage of Oklahoma Providers deserve the same.

For more information on becoming a American Health Advantage of Oklahoma contracted Provider, please contact Network Operations at 1-866-583-4649; TTY 1-833-312-0046 or via email at networkservices@amhealthplans.com.

American Health Advantage of Oklahoma’s business is governed by complex, demanding, and ever-changing laws, rules, and regulations.

We are committed to acting with integrity and making decisions based on the highest standards of ethical behavior, including complying with applicable laws and regulations.

To provide quality health care services in compliance with these laws, American Health Advantage of Oklahoma has developed a compliance program that provides guidelines and assigns responsibilities for controls and procedures that promote consistent and proper organizational behavior.

The Compliance Program has been developed to assist in establishing a culture within American Health Advantage of Oklahoma that promotes the prevention, detection, and resolution of instances of conduct that do not conform to federal and state law and federal and state health care program requirements.

The Compliance Program describes our commitment to ethical business practices and behavior. Additionally, the Compliance Program provides the framework to assure that our employees, including officers, managers, volunteers, interns, Board of Directors, vendors (contractors, subcontractors), and first-tier, downstream, and related entities (FDRs) comply with the applicable legal and ethical standards of conduct, including our standards of conduct and requirements to prevent, detect, and mitigate fraud, waste, and abuse (FWA).

American Health Advantage of Oklahoma contracts with the Centers for Medicare & Medicaid Services (CMS) to provide health care and prescription drug benefits under Medicare Advantage and Medicare Part D programs to our Medicare beneficiaries. As a part of these contracts, CMS requires American Health Advantage of Oklahoma to oversee our first tier, downstream, and related entities (FDRs) who provide health care or administrative services.

As an FDR for American Health Advantage of Oklahoma, you are an important partner in the continued success of our Compliance program.

Medicare requires FDRs to participate in the American Health Advantage of Oklahoma Compliance program, and we are committed to providing you with the tools needed to ensure you meet the obligations of this program. Our Standards of Conduct and other resources for reporting concerns or issues are available to you.

CMS requires our FDRs to complete Medicare FWA and general compliance training on an annual basis.

In accordance with CMS guidance, providers who have enrolled in Medicare Parts A or B or are accredited as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are deemed to have met the requirement for the FWA training and education. However, this does not exempt your organization from having to complete the general compliance training on an annual basis.

In order to ensure consistency and reduce the burden on providers, suppliers, contractors, and organizations, CMS has developed a web-based training module that can be used to satisfy the FWA and the general compliance training and education requirements.

FDRs must satisfy CMS’ general compliance and FWA training requirements. FDRs can complete the general compliance and/or FWA training modules available through the CMS Medicare Learning Network (MLN). Or, FDRs may download, view or print the content of the CMS standardized training modules from the CMS website to incorporate into their organization’s existing compliance training materials/systems. The CMS training content cannot be modified to ensure the integrity and completeness of the training.

Regardless of the training program used, American Health Advantage of Oklahoma requires FDR agents to complete the FWA training within 90 days of contracting with American Health Advantage of Oklahoma and annually thereafter.

Thank you for your cooperation. If you have any questions about whether your organization is required to complete FWA and general compliance training, or whether your organization’s internal training or third-party training is sufficient, please contact the American Health Advantage of Oklahoma Compliance Officer at (866) 205-2866. If you need assistance or have comments, please email Compliance@AmHealthPlans.com.

Oklahoma Superior Select, Inc., doing business as American Health Advantage of Oklahoma has implemented a Compliance Hotline for our Members; employees; first-tier, downstream, and related entities; and other contractors and agents.

The Compliance Hotline provides a mechanism for callers to report activity related to known or suspected non-compliance with American Health Advantage of Oklahoma’s mission; policies and procedures; Compliance program; Standards of Conduct; or any Federal, State, or local laws and regulations.

All calls to the Compliance Hotline will be treated as confidential and private to the fullest extent possible.

Compliance Hotline: 1-866-205-2866 (toll free)

If you are not comfortable or able to make a report via the Compliance Hotline, you may send a written report by mail to:

American Health Advantage of Oklahoma
Attn: Compliance
201 Jordan Road, Suite 200
Franklin, TN 37067
Or Email: Compliance@AmHealthPlans.com

Whether reporting by telephone or in writing, please provide as much detail as possible, including, but not limited to, names, dates, times, locations, and the specific conduct you feel may violate the law or American Health Advantage of Oklahoma Policy.

No individual making a good faith report of a suspected violation shall be retaliated against. However, any individual who knowingly makes a false allegation shall be subject to disciplinary action in accordance with American Health Advantage of Oklahoma Policy.