OMES Employees Group Insurance Division

Nominate a Provider for the HealthChoice Provider Network
If you know of a medical or dental practitioner or a facility that is not a member of the HealthChoice Provider Network, and you would like them to join, you can nominate them for participation. Leave us some basic information and we will contact the provider, on your behalf, and ask them to consider contracting with HealthChoice to become a Network Provider.
* Indicates Required Field
The contracting process may take several weeks or longer. The provider must satisfy our business requirements and meet our contracting standards. Your nomination does not guarantee the provider is eligible for participation in the network or will agree to contract with us. Please provide the following information so we can contact your provider:
*Enter Provider Name
Select Specialty
*Enter Phone Number (no dashes e.g. 5554443333)
*Enter Address
*Enter City
*Select State
*Enter ZIP Code (no dashes e.g. 555554444)
*I am a Member Provider Insurance/Benefits Coordinator Other
If a facility is a member of the HealthChoice Provider Network, they can also be nominated for the HealthChoice Select program. Only facilities can participate in HealthChoice Select, not individual practitioners.
Would you like to nominate this facility for HealthChoice Select? Yes No
Is this facility currently a member of HealthChoice Provider Network? Yes No
Select Service Type:
If you would like us to follow up with you on the outcome of your nomination, please enter your contact information below.
Enter First Name
Enter Last Name
Enter Phone Number (no dashes e.g. 5554443333)
Enter Email Address
To check the status of your nomination, contact HealthChoice Network Management at 1-405-717-8790 or toll-free 1-800-543-6044. TTY/TDD users call 1-405-949-2281 or toll-free 1-866-447-0436. Email inquiries can be sent to EGID.NetworkManagement@omes.ok.gov.
If you would like to receive a confirmation email upon submission of this form, please enter your email here.
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Nominate a Provider for the HealthChoice Provider Network