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Oklahoma Services Request Cover Sheet
Category:
State:
Multi-State
Control #:
US-143-AZ
Format:
Word;
PDF;
Rich Text
Instant download
Description
How to fill out Services Request Cover Sheet?
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FAQ
Oklahoma SoonerCare | Medicaid. Official websites use .gov. A .gov website belongs to an official government organization in the United States.
These can include a U.S. passport, certificate of citizenship or certificate of naturalization, or birth certificate showing U.S. birthplace or its territories (for citizenship) and a driver's license (for identity). (See SoonerCare Citizenship Fact Sheet for a detailed list of acceptable proof.)
PHARMACY REQUESTS Authorization Unit (MCAU), approves or disapproves each medication authorization request on behalf of the OHCA. The MCAU staff can be reached by phone at 405-522-6205 option 4 / 800-522-0114 option 4 or by fax at 405-271-4014 / 800-224-4014.
The SoonerCare patient dismissal process for SoonerCare Choice providers is fully electronic and can be completed using OHCA's secure provider portal. Who can submit the patient dismissal request?
Members who need to make a change to their case can be do so online through their SoonerCare account. You can make changes to your address, household size, income, and tax filing status. Changes to household size should be reported within 10 days of the change.
Total household income is used for eligibility for both children and adults. SoonerCare uses monthly ?gross? income totals.
SoonerPlan is Oklahoma's family planning program for women and men who are not enrolled in regular SoonerCare services.
Pharmacy PA Requests should be faxed to: OKC Metro (405)271-4014 or Toll-Free (800)224-4014.
Soon-To-Be-Sooners (STBS) (effective: 4/1/2023) Size of HouseholdMonthly IncomeAnnual Income1$2,552$30,6242$3,453$41,4363$4,352$52,2244$5,250$63,0004 more rows ?
Providers must verify if a member has other insurance prior to services rendered. The primary insurance guidelines must be met for SoonerCare to consider payment. Providers accept the SoonerCare allowable as payment in full and may not bill the member for any remaining balance.
