Please follow the Enrollment Instructions below to become an electronic submitter for Oklahoma Medicaid.

If you are a contracted provider and have not received your Internet Pin letter, please call their helpdesk at 1-800-522-0114 to request your Pin.

Required Documents for those applying for new Submitter Id's

The following documents are required enrollment documents that must be completed, signed, and returned to the EDS office prior to initiation of electronic claims submission or inquiry.

1. EDI/ERA Application for Providers
2. EDI/ERA Application for Billing Agents(For Billing Services ONLY)
3. Electronic Data Exchange Agreement (For Billing Services ONLY - print 2 copies)

If the above links do not work properly, please download the forms directly from the website: www.okhca.org/providers

If you have any questions regarding any of the documents in this package, please call the EDS EDI Technology Support Center at 1-800-522-0114.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Oklahoma SoonerCare EDI Application for Providers

Section 1

• Header: Choose "New Applicant"

• Enter your Organization/Practice or Provider Name and Enter your Provider number and NPI number

• Enter your demographic information

• Enter the contact information for the main contact person(s) for your office

• Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Please indicate the EDI transaction type being requested to send/receive

• Please chose the following:

  • 837 Professional (for CMS 1500 claims) or 837 Institutional (for UB04 claims)

  • 835 Remittance Advice (for Electronic EOB's)

Section 2

• Select the option you would like for your paper remits

• Enter your Provider Numbers and Provider Names

• On the designated receiver's section for ERA's, leave the Receiver ID blank and fill in your business name, name of the contact person for your office, and your demographic information.

• Billing Services: If you are to receive your provider's ERA's, they must fill out one of these forms and enter YOUR Receiver ID and Business name to authorize you to receive their Remits.

Section 3

• Sign and Date

Oklahoma SoonerCare EDI Application for Trading Partners

Section 1

• Header: Choose "Billing Agent" (SoonerCare considers every direct submitter a "Billing Agent")

• Enter your Business Name and leave Submitter ID blank

• Enter your demographic information

• Enter the contact information for the main contact person(s)for your office

• Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Section 2
Please indicate the EDI transaction type being requested to send/receive

• Please chose the following:

  • 837 Professional (for CMS 1500 claims) or 837 Institutional (for UB04 claims)

  • 835 Remittance Advice (for Electronic EOB's)

Section 3

• Sign and Date

Electronic Data Exchange Agreement (For Billing Services ONLY)

• Header - Complete the first paragraph with your Business Name and Tax ID number

• Section 2.2 - Enter your Business Name, Address, and email address

• Section 2.3 - Providers, initial the first line; Billing Services, initial the 2nd line

• Section 9.1 - Complete the "Contractor" section

SoonerCare Provider or Fiscal Agent Disclosure of Ownership

• Please complete this form in it's entirety. If you have any questions regarding how to complete this form, please contact Oklahoma Medicaid's EDI department at 1-800-522-0114.

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

Electronic Data Systems
Attn: EDI Department
2401 NW 23rd Street, Ste. 11
Oklahoma City, OK 73107

Fax: 405-416-1426

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filling claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center at 1-800-522-0114.

Testing

Once you have received your Submitter ID and Password from EDS, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to EDS.

Please have claims ready to be sent for testing. We will need to submit two batches, with a minumim of 12 claims in each file. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment, but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.