ADvantage Provider Frequently Asked Questions

1. How do I make a referral for ADvantage services?
2. What do I do when I have Member that may not meet ADvantage Program appropriateness or Level of Care?
3. How do I get answers to my question about Case Management standards, the Conditions of Provider Participation, or other contractual documents
4. What if I have a question about Member specific service plan authorization decision?
5. What if I have a claim, PA or eligibility issue?
6. What is the status of my PA?
7. Why was my request for ADvantage Program PA denied?
8. How do I change my agency's referral status or add or delete services?
9. What do I do when I have a grievance or complaint to report on behalf of a Member?
10. What do I do when a Member has a grievance or complaint regarding my agency or its services and or staff and I cannot get it resolved to our mutual satisfaction?

How do I make a referral for ADvantage services?
Complete Part I of the UCAT Part I with the applicant. Completed forms for Tulsa and Oklahoma Counties should be faxed to 405-230-8018. All others should be submitted to their local county DHS office.
Individuals may also initiate the application process by calling the ADvantage Administration Resource Center at 1-800-435-4711. The information to complete the UCAT Part I will be taken over the phone and forwarded to the appropriate DHS county office.
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What do I do when I have a Member that may not meet ADvantage Program appropriateness or Level of Care?
Please fax the member's initials, ID#, and your written request to Escalated Issues at 405-230-8024, Attn: Escalated Issues or mail information to, ASD OKDHS 823 S. Detroit, 4th Floor, Tulsa Oklahoma 74120, Attn: Escalated Issues. Whether you send your documentation by fax or mail, please also contact ProviderQuestions to let us know that the documentation has been sent. This will help ensure that we receive it.
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How do I get answers to my question about Case Management Standards, the Conditions of Provider Participation, or other contractual documents?
Case Management Standards and Conditions of Provider Participation are accessible through the ADvantage Provider website under "Contract Documents". If questions remain, then e-mail ProviderQuestions.
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What if I have a question about a Member specific Service Plan Authorization decision?
Agencies needing assistance from the AAU about a specific service plan should email ProviderQuestions for assistance with service plan issues.
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What if I have a claim, PA or eligibility issue?
First, review the service plan to determine if there are any conditions (incorrect pay source, not ADvantage covered etc.) present.
Second, contact the case manager to determine if there were any changes to the service plan that could affect this.
Third, if you are still unable to resolve the issue, submit the ADv21 form, located on the ADvantage Provider website under "Case Management Forms". You will find both the form and the instructions for completion. The Claims Department will then send you a fax confirming receipt of the ADv21 request and an approximate timeframe for resolution.
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What is the status of my PA?
Contact the ADvantage Administration Unit via ProviderQuestions.
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Why was my request for ADvantage Program PA denied?
An ADv21 form must be completed and faxed to the Claims department (918-933-4981) for assistance in resolving any PA, eligibility or claims issue. The ADv21 form and instructions can be found on the website under "Case Management Forms". Please attach a copy of the claims denial if possible.
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How do I change my agency's referral status or add or delete services?
Contact the ADvantage Administration Unit via ProviderQuestions. Your inquiry will be forwarded to the Contracts Department.
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What do I do when I have a grievance or complaint to report on behalf of a Member?
Contact the ADvantage Administration Unit via ProviderQuestions.
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What do I do when a Member has a grievance or complaint regarding my agency or its services and or staff and I cannot get it resolved to our mutual satisfaction?
Submit an email to ProviderQuestions regarding the request for assistance and someone with the Client Relations department will be in touch with you by phone to assist in resolving the condition.
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