Contracts and Applications

As part of the transition, effective July 1, 2012, OSEEGIB will begin accepting a completed Oklahoma Uniform Credentialing Application (ODH Form 606) and a completed HealthChoice, Department of Rehabilitation Services, or Department of Corrections supplement in place of the Network Application for all professional provider contracts as referenced in section IV. SERVICES AND RESPONSIBILITIES of the contracts. The OUCA and OUCA supplement will be available on the provider websites, and an application will no longer be included as part of the professional Network Provider contracts. OUCA does not apply to institutional or facility providers.

Applications and Signature Pages can be Completed Online

HealthChoice wants you to be aware that a change was made to the signature pages of all HealthChoice Network Provider Applications.  James L. Reese, II, is the new Deputy Administrator for Operations and Chief Information Officer.  Applications have been modified to reflect this change. It is important that you begin using the new applications and discard older versions.

In addition, applications can now be completed and submitted online if you have the ability to email an electronic signature; otherwise, applications can be signed, scanned in, and then emailed.  If this is not an option for you, complete the application and mail or fax it to:

HealthChoice Provider Relations Division 
3545 NW 58 Street, Suite 110
Oklahoma City, OK 73112
                              
FAX:  1-405-717-8977

Please direct all email submissions to:   OSEEGIBproviderrelations@sib.ok.gov