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OAC 317:35-17-22. Billing procedures for ADvantage services

OklahomaregulationOklahoma Health Care Authority· effective 2025-09-01

What this rule requires your agency to do

  • 1Providers must not bill for a unit of time when not more than one-half of a timed unit is performed; services of less than eight (8) minutes cannot be rounded up to a billable fifteen (15) minute unit, while services of eight (8) to fifteen (15) minutes are rounded up to one billable unit. (OAC 317:35-17-22(f)(1)-(2))(OAC 317:35-17-22. Billing procedures for ADvantage services)
  • 2Paid claims must be consistent with service plan authorizations and documentation of service provision; unsupported paid claims are referred to the OHCA Clinical Provider Audits Unit for investigation. (OAC 317:35-17-22(c))(OAC 317:35-17-22. Billing procedures for ADvantage services)
  • 3The provider must document the amount of time spent for each service per OAC 317:30-5-763. (OAC 317:35-17-22(f))(OAC 317:35-17-22. Billing procedures for ADvantage services)
  • 4Service time of personal care, case management, home health care, nursing, advanced supportive/restorative assistance, in-home respite, CD-PASS, personal services assistance, and advanced personal services assistance must be documented through the designated statewide EVV system when provided in the home; providers are required to use the EVV system. (OAC 317:35-17-22(e))(OAC 317:35-17-22. Billing procedures for ADvantage services)
  • 5All contracted providers for ADvantage Waiver services must submit billing to OHCA/SoonerCare using the appropriate designated software or web-based solution for all claims transactions; when the designated system is unavailable, providers submit billing directly to OHCA. (OAC 317:35-17-22(d))(OAC 317:35-17-22. Billing procedures for ADvantage services)

Applies to: ADvantage waiver contracted providers; home care agencies

Sets billing rules for ADvantage services, including prior-authorization-based billing, mandatory statewide EVV documentation of in-home service time, time documentation per service, and the eight-minute rounding rule for fifteen-minute units.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.