OHCA Provider Services
Provider Services Mission Statement
OHCA’s 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 virtual or telephonic educational meetings with providers. These can include current or new information about program policies and procedures.
- Plans and participates in webinars for provider virtual trainings.
- 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 OHCA 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.
Provider Educational Specialists
Oklahoma SoonerCare has a team of educational specialists 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 virtual visits and webinars, staff can also assist providers with contract renewals through Electronic Provider Enrollment.
The main focus of an educational specialist is:
- Training newly enrolled providers and billers on the SoonerCare Provider Portal.
- Establishing and maintaining relationships with contracted providers to insure correct claim adjudication and resolution.
- Conducting monthly webinar trainings.
Webinars, including SoonerCare 101 training sessions, are scheduled monthly 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. Currently scheduled trainings can be seen on our Training Page. One-on-one and group training sessions can also be arranged at the request of individual provider groups or associations.
Scheduling Provider Visits
A telephonic or virtual visit with a provider education specialist may be requested for specific training on a topic. To assist the provider education specialists in planning and structuring the visit or group training, the following information should be emailed to SoonerCareEducation@okhca.org:
- Provider type attending the training.
- Number of attendees.
- Time and location requested.
- Issues to be addressed.
Point of contact if additional information is needed prior to the event.