SoonerCare Physician Assistant Contract

The following documents must be filled out and submitted together in order for OHCA to process your enrollment:

Step 1. Print the SoonerCare Physician Assistant Contract and fill it out (all forms are included);

Step 2. Include a copy of your current license and proof of malpractice insurance; (If you are enrolling only as a Traditional provider, proceed to Step 4 below.)

Step 3. If you choose to enroll as a Choice and/or O-EPIC PCP, see below;

CHOICE

If you want to enroll as a Choice PCP, print the Choice/Medical Home Physician Assistant Addendum 1 (attachments A, B, and Self Evaluation Tier 1 are included), complete the required Self Evaluation Form and attach to contract. Also, please print out the Uniform Credentialing Application and fill it out. Completion of Self Evaluation Tier 2 or Self Evaluation Tier 3 is optional.

Insure Oklahoma, Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC)

If you want to enroll as a provider for the Insure Oklahoma program, print the Insure Oklahoma Physician Assistant Addendum 2 (the Insure Oklahoma Program Attachment is included), complete the required form and attach to contract. Also, please print the Uniform Credentialing Application (if also a Choice PCP, only complete once) and fill it out.

Step 6. Mail the completed contract with all forms to:

Oklahoma Health Care Authority
ATTN: Provider Enrollment
Post Office Box 54015
Oklahoma City, Oklahoma 73154

Failure to complete and attach all forms, licenses and certifications will delay your contract which could cause delays in your payment.