Manuals, Forms and Resources

Manuals

Forms

Oklahoma Complete Health Forms

Notification of Pregnancy (NOP) Letter and Form
Outpatient Medicaid Prior Authorization Form (PDF)
Inpatient Medicaid Prior Authorization Form (PDF)
Provider Appeal Form (PDF) - This form is to be used for appeals where the service has already been rendered and the claim has been denied. For pre-service appeals please use the Grievance/Appeal Form located under Member Forms.
Pharmacy Retail Prior Authorization Form (PDF)
CoverMy Meds Link This is an external link that will take you outside the Oklahoma Complete Health website.
MedPharm (JCODE) PA form (PDF) Coming Soon
Telemedicine Guide (PDF) Coming Soon
Weight Watchers Baseline Form (PDF) Coming Soon
On-Site Interpreter Request Form (PDF)
Outpatient Authorization Supplemental Form (PDF)
Primary Care Provider (PCP) Request for Member Release Form
Primary Care Provider Change Form Fillable (PDF)
Psychological/Neurological Testing Authorization Form (PDF) - Instructions for attaching the form to Availity:
- 1. Go to the Authorization/Referral Dashboard. Find the authorization request you want to add a file to.
- 2. Open the authorization. In the Actions column, select "View Details."
- 3. Select “Add Attachments.” On the detail screen, click "Add Attachments."
- 4. Add your file. In the Add Attachment(s) section, select "Add File." Choose the file from your computer and select "Open."
- 5. Confirm the file uploaded. The file will appear in the Add Attachment(s) section once uploaded.
- 6. Add more files if needed. Select "Add Another File Attachment" to upload additional files.
- 7. To remove a file, select the trash can icon next to the file.
- 8. Submit the authorization. When you are finished attaching files, select "Submit" at the bottom of the page.