Benefits for Immunizations/Vaccinations and Their Administration Under the Pharmacy Plan
Benefits for Preventive Services
ClaimCheck and Clear Claim Connection
Coordination of Benefits
Facility Dispute Resolution Procedures
Fee Schedule Requests
Fee Schedule Updates
HealthChoice Contact Information
HealthChoice Pharmacy Benefits
Joining the HealthChoice Provider Network
Maternity Program- Mommy and Me
Medicare Part D
Network Management Unit
Network Provider Termination
Osteopathic Manipulation, Speech Therapy, Physical/Occupational Therapy, and Chiropractic Therapy Guidelines
Preventive Services and Use of Modifier 33
Prior Authorization Process for Non-Preferred Medications
Provider Claim Appeals
HealthChoice is a managed health care program providing comprehensive health and dental benefits to over 150,000 state, education, and local government employees, former employees, survivors, and their covered dependents.
HealthChoice is administered by the Office of Management and Enterprise Services (OMES) Employees Group Insurance Division (EGID), an agency of the State of Oklahoma. The HealthChoice plans are a partnership among providers, members, and EGID in the delivery of health care services and products, that helps control costs, assists in the provision of high quality health care, and enhances provider/patient relationships. The HealthChoice benefit structure offers financial incentives to encourage Plan members to utilize HealthChoice Network Providers.
EGID provides health care benefits in accordance with the provisions of Oklahoma Statutes, Title 74, Sections 1301, et seq. The information provided in this manual is a SUMMARY of the benefits, conditions, limitations, and exclusions of the HealthChoice High, High Alternative, Basic, Basic Alternative, S-Account, and Dental Plans. It should not be considered an all-inclusive listing.
While the HealthChoice Network Provider Manual is a summary only and is not intended to be all-inclusive, its contents should offer providers and their staff vital information regarding the most important aspects of the Provider Network.
Plan benefits are subject to conditions, limitations, and exclusions. These conditions, limitations, and exclusions are described and located in Oklahoma Statutes, Administrative Rules, and Administrative Procedures adopted by the Plan Administrator. You can obtain a copy of the official Rules from the Office of the Oklahoma Secretary of State. An unofficial copy of the Rules is available on this website on the home page. Under the heading About EGID, click the link Administrative Rules. A copy of the Administrative Procedures can be obtained from the Plan Administrator.
The sections of the provider manual can be found in the menu to the left. Please click on the link to view that section. The following link is a printable version of the complete manual:
HealthChoice Provider Manual (341KB)
A description of the plans offered by HealthChoice can be found in the member handbooks. The following links are to the HealthChoice member handbooks:
HealthChoice High Option & Basic Health Plans Handbook (1MB)
HealthChoice Dental Insurance Handbook (883KB)