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 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
The main focus
of a field representative is:
newly enrolled providers and billers on the SoonerCare Provider
and maintaining relationships with contracted providers to insure correct
claim adjudication and resolution
bi-annual provider workshops
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.
To assist the
field representative in planning and structuring the visit or group training,
the following information should be provided:
type attending the training
and location requested
to be addressed
of contact if additional information is needed prior to the event
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)
SoonerCare Field Representatives