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Contracts and Applications

Application

Oklahoma Uniform Credentialing Application 

Oklahoma Uniform Credentialing Application Supplement

Oklahoma Uniform Credentialing Applications (OUCA) will not be considered complete unless accompanied by an OUCA Supplement and the required attachments.

You can complete the applications and contracts by entering the required information in the open fields while it is displayed on your computer monitor. Completing them electronically makes them easier to read which results in fewer mistakes, questions and delays in processing your application. You can then print the application, sign it, and mail, email or fax it to:

HealthChoice Network Management
3545 N.W. 58th St., Ste. 600
Oklahoma City, OK 73112
EGID.NetworkManagement@omes.ok.gov
FAX: 405-717-8977


Provider Contracts

An OUCA application and supplement must be completed and submitted with the signature page from the most appropriate contract.

Dental
Dietician
Clinical Nurse Specialist
Nurse Practitioner
Oral Surgeon
Pharmacist
Physician
Physician Assistant
Provider


Facility Contracts and Applications

Ambulance/Air Ambulance
Ambulatory Surgery Center
Durable Medical Equipment
Facility Contract
Hearing Aid Vendor
Home Health Care Agency
Hospice
Independent Diagnostic Testing Facility
Infusion Therapy
Laboratory
Long-Term Acute Care Facility Contract
Pathology Group Contract
Wig/Scalp Prosthesis

First Amendment of EGID Network Facility Contract
Radiology and Sleep Study Providers must complete and sign the First Amendment of the HealthChoice Network Facility Contract. The amendment must accompany a completed Network Facility Application and signed signature page when it is submitted to EGID Network Management 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.