Skip to Main Content

Provider/Practitioner Changes

For all changes and/or updates, please refer to the Instruction Guide before submitting any of the below forms.

  • Instruction Guide
  • Fillable Provider Change Form (PDF) - Any changes in address, telephone and fax numbers, NPI numbers, and provider status (moved out of area, retiring, capacity changes, etc.) must be communicated to Oklahoma Complete Health through this form.
  • Preferred Roster (Excel) - Any practitioner additions, terminations or changes for multiple practitioners must be emailed to Oklahoma Complete Health using this Roster. Note: For delegated credentialing, the CAQH number is not necessary on the Roster. How to complete the Roster
    • Click the above “Preferred Roster” hyperlink
    • Select “Save” to save to your computer
    • Locate and open the saved Roster from download
    • Review “Instruction Page” tab
    • Complete all applicable fields in yellow on the “Auxiliary Providers” tab
    • Save and email to
  • Collaborative Practice Information for Allied Health Professional Dependent Practitioners (PDF) - This form is used for Mid-level practitioners to list their supervising physician and what sponsoring, collaborating and hospital admitting arrangements are in place.
  • Provider Profile Sheet - Alternative to the Preferred Roster. For practitioners who are already registered with CAQH ProView, additions may be submitted using the Provider Profile Sheet.
  • Fillable W-9 form (PDF)
Last Updated: 02/20/2023