DOC Contracts and Applications

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Applications

• - Oklahoma Uniform Credentialing Application
• - OUCA Supplement

Oklahoma Uniform Credentialing Applications (OUCA) will not be considered complete unless accompanied by an OUCA Supplement and the required attachments.

Completed OUCA and DOC facility applications can be signed, scanned in, and then emailed. If this is not an option for you, mail or fax it to:

DOC Network Management
P.O. Box 57630
Oklahoma City, OK 73157-7630
FAX: 1-405-717-8977

Please direct all email submissions to your designated contracting representative. If you are not aware of your representative direct them to: EGID.DOCNetworkMangement@omes.ok.gov .

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Provider Contracts

(An OUCA application and supplement must be completed and submitted with the signature page from the most appropriate contract)

• - Network Physician Contract
• - Network Provider Contract
• - Dental Contract

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Facility Contracts and Applications

• - Ambulatory Surgery Center Contract
• - Laboratory Contract
• - Long Term Acute Care Facility Contract
• - Network Facility Contract

- First Amendment of Oklahoma DOC Network Facility Contract
*Radiology, Sleep Study Providers and Independent Diagnostic Testing Facilities must complete and sign the First Amendment of the DOC Network Facility Contract. The amendment must accompany a completed Network Facility Application and signed signature page when it is submitted to DOC Network Management to complete the application process. If the amendment is not received as an attachment to the application, it will be considered incomplete which will delay your effective date as a Network Provider.