Member Suspension Process

Updated on: 06/22/2026

Provider Type(s) for Which These Instructions ApplyProgram(s) for Which These Instructions Apply
All ProvidersAll Programs

ADvantage, Medically Fragile and Living Choice this process will be used by both the Case Manager and other Non-Case Manager users anytime a Member Suspension of services is needed.

SPPC this process will be used by the Home Care Agency

*Click on your role to navigate to the appropriate instruction section.

Case Manager (ADvantage, Medically Fragile, Living Choice) OR Home Care Agency (SPPC) Actions

  1. Open the Member Record
  2. Select the Provider Enrollments Tab
    Member Record tabs showing Provider Enrollments Tab highlighted
  3. Click on the first Provider record. 
    Note: Provider records that include OKDHS or OHCA in the name should not be updated by Case Managers. 
    Provider Enrollments list showing provider records to select from
  4. Update the “Member Status to Provider” to reflect “Suspended”
    Provider Enrollment form showing Member Status to Provider dropdown with Suspended option to be selected
  5. Hover over “File”
    Select “Save and Close Provider”
    File menu expanded showing Save and Close Provider option highlighted
  6. If there are additional “Open” Provider records, repeat steps 3 to 5. 
  7. Hover over “Reports” on the Menu bar
    Select “Case Processor by Provider”
    Reports menu expanded showing Case Processor by Provider option highlighted
  8. Navigate to the Notes Tab in the Member Record
    Member Record tabs showing Notes Tab highlighted
  9. Add a Note
    • Note Type = Service Suspension, Note Sub-Type = use the appropriate reason for the suspension
    • Make sure to add all Case Processors listed on the “Case Processor by Provider” report as a Note Recipient. 
      Add Note form showing Note Type set to Service Suspension with Note Sub-Type for suspension reason, and Note Recipients section for adding Case Processors from the report
    • Living Choice and Medically Fragile Waiver cases – The OKDHS or OHCA Team Member should be added as a Note Recipient.
    • ADvantage and SPPC cases – The OKDHS Team Member should not be added as a Note Recipient. 
  10. Navigate to the Event History Tab and add an Event Detail

Non-Case Manager Actions

  1. If notified of a suspension via a note from the Case Manager, the user must ensure that services are suspended in accordance with their agency’s internal procedures.
    OR
    If the user is the first to identify the need for a service suspension, the following steps should be followed: 
  2. Navigate to the Division Tab
    Member Record tabs showing Division Tab highlighted
  3. Review the record for the assigned Case Manager
    Division Tab showing assigned Case Manager information
  4. Navigate to the Notes Tab 
    Member Record tabs showing Notes Tab highlighted for Non-Case Manager navigation
  5. Add a Note
    • Note Type = Notification, Note Sub-Type = Request for Service Suspension
    • Make sure the Case Manager identified on the Division Tab is added as a Note Recipient
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