New! 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
Provider Contracts
Dental (HCDCv1.0)
Dietician (HCDCv1.1)
Clinical Nurse Specialist (HCCNSv1.2)
Nurse Practitioner (HCNPCv1.1)
Oral Surgeon (HCOSCv1.1)
Pharmacist (HCPCv1.1)
Physician (HCPCv1.0)
Physician Assistant (HCPACv1.1)
Provider (HCCv1.0.pdf)
Facility Contracts
Ambulance/Air Ambulance (HCACv1.1)
Ambulatory Surgery Center (HCASCCv2.3.5)
Durable Medical Equipment (HCDMEv1.1)
Facility Contract (HCFCv1.2)
Hearing Aid Vendor (HCHACv1.1)
Home Health Care Agency (HCHHCv1.1)
Hospice (HCHCv1.1)
Independent Diagnostic Testing Facility (HCIDTFv1.2)
Infusion Therapy (HCITCv1.1)
Laboratory (HCLCv1.1)
Long-Term Acute Care Facility Contract (HCLTACFCv1.1)
Pathology Group Contract (HCPGCv1.1)
Wig/Scalp Prosthesis (HCWSPv1.1)
First Amendment of OSEEGIB Network Facility Contract (HCFCv1.2)
*Radiology and Sleep Study Providers must complete and sign the First Amendment of the OSEEGIB Network Facility Contract. The amendment must accompany a completed Network Facility Application and signed signature page when it is submitted to OSEEGIB Provider Relations to complete the application process. If the amendment is not received as an attachment to the application, it will be considered incomplete which will delay your effective date as a Network Provider.