OHCA Provider Services


Provider Services Mission Statement

OHCA Provider Services Unit is committed to professional and efficient service while maintaining a strong provider base through recruitment, retention and advocacy for the SoonerCare provider community. Our goal is to assist the provider network with claims resolution, programs education, and policy interpretation. Our team consists of professional representatives who are committed to establish a long term partnership with our network providers.

SoonerCare Provider Services Unit Structure 

  • Conducts provider on-site educational meetings with participating and nonparticipating providers with current and new information about program policies and procedures.
  • Plans and participates in presentations at statewide provider training seminars and individual training classes.
  • Develops educational materials for provider staff to enhance their understanding of the SoonerCare programs.
  • Researches and interprets Oklahoma SoonerCare policies for providers and other state agencies and educates staff within the Oklahoma Health Care Authority and its contracted partners.
  • Answers complex telephone and written inquiries, correspondence, secure e-mails and complaints.
  • Works with other entities to coordinate resolution of provider issues.
  • Coordinate with Provider Enrollment to facilitate local and out of state contracts.
  • Communicates and advises providers on updates to the SoonerCare program.
  • Researches and resolves legislative inquiries.
  • Reviews and process retrospective administrative referrals for the SoonerCare specialty provider network.

SoonerCare Field Representatives

Oklahoma SoonerCare has a team of regional field representatives with in-depth knowledge of SoonerCare billing requirements and claim processing procedures. Training is offered on billing through the Provider Portal and use of the Eligibility Verification System (EVS) and Electronic Data Interchange (EDI). In addition to providing training through on-site visits and workshops, field representatives also assist providers with contract renewals through Electronic Provider Enrollment.   

The main focus of a field representative is:  

  • Training newly enrolled providers and billers on the SoonerCare Provider Portal  
  • Establishing and maintaining relationships with contracted providers to insure correct claim adjudication and resolution  
  • Conducting bi-annual provider workshops  

Training Opportunities  

Workshops, webinars and SoonerCare 101 training sessions are scheduled throughout the year to educate providers on Oklahoma SoonerCare claim processing procedures, billing requirements and policy updates. These opportunities will be announced through broadcast and banner messages, web alerts and newsletters. One-on-one and group training sessions can also be arranged at the request of individual provider groups or associations.  

Scheduling Provider Visits  

To assist the field representative in planning and structuring the visit or group training, the following information should be provided:  

  • Provider type attending the training  
  • Number of attendees  
  • Time and location requested  
  • Issues to be addressed  
  • Point of contact if additional information is needed prior to the event  

Contacting Your Field Representative 

Providers may contact their field representative by telephone or email to request a visit. Field representatives travel multiple days per week, therefore please allow a minimum of 48 hours for telephone calls and emails to be returned.

For immediate assistance with claim research or resolution of other Oklahoma SoonerCare issues contact the OHCA Call Center at (405) 522-6205 or (800) 522-0114. 

SoonerCare Field Representatives