Manuals, Forms and Resources

Manuals 

• Provider Manual (PDF)
• Provider Billing Manual (PDF) 
• Prior Authorization Guide (PDF)
• Provider Orientation Materials (PDF) - coming soon

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) Transfer form

Provider Contracting and Credentialing

• Contract Request Form (PDF)
• Hospital – Facility Provider Application Coming Soon
• Ownership and Controls Disclosure Form Coming Soon
• Practitioner Data Form Coming Soon
• PDM Credentialing Checklist (PDF)
• W9 Form