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(Please type or print). SoonerCare/Insure Oklahoma Referral Form. OHCA Form SC-10 effective September 1, 2017. (Updated 9/20/2017). Member Name.

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Related content

SoonerCare/Insure Oklahoma Referral Form Member...
Sep 20, 2017 — Referring Provider ID Number. NPI#. (10 digits). • This referral is...
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PROVIDER REFERRAL FORM MEMBER NAME DATE OF ...
PROVIDER REFERRAL FORM. MEMBER ... o REASON FOR CASE MANAGEMENT REFERRAL: SOONER CARE...
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The term income is defined as a gross gain or gross recurrent benefit that derives from labor, business, property, retirement and other benefits or sources that are available for use on a regular basis.

If you are applying for SoonerCare for the first time, you must provide one-time proof of your U.S. citizenship and identity. This flyer explains how to send in that proof. Newborn children (under age one) of SoonerCare members do not have to show proof.

Administrative referrals may be requested using the SC-14 form. The retrospective administrative referral request for specialty services is requested from OHCA within 30 calendar days of the specialty care date of service. The request must include appropriate documentation for OHCA to approve the request.

Oklahomans may qualify for SoonerCare Services* if their tax household's Modified Adjusted Gross Income* (MAGI) is within the following guidelines....SoonerPlan. (effective: 4/1/2023) Size of HouseholdMonthly IncomeAnnual Income7$7,949$95,3888$8,850$106,2006 more rows

WHAT IS SOONERCARE? SoonerCare is the brand name given to Oklahoma's Medicaid program. Medicaid is a program that covers medical expenses for certain groups of people who have limited income and resources. The Oklahoma Health Care Authority is the state agency that administers the program.

SoonerCare (Oklahoma Medicaid) covers many health care services. However, there are limitations that apply to ensure only medically necessary services are provided. Some services are for children only. The benefits and coverage outlined may change.

Members enrolled in SoonerCare Choice must have a referral from the PCP in order to see a specialist. Certain SoonerCare members are ineligible for the SoonerCare Choice program.

ing to the report, Oklahoma was the only state to process and conduct 100% of applications in less than 24 hours during the first three months of 2022.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232