APS Certification Request Form
Use this form to certify diagnostic imaging services, specific outpatient surgeries and inpatient health care as
specified in the Provider Network contracts and identified at
www.sib.ok.gov/precert.
Electronic Funds Transfer Form
Use this form to sign up for EFT claim payments which are sent directly to your bank account. If you change a
billing address and/or tax identification number you must also complete and submit this form with your
change request.
HealthChoice Provider Update Forms
Provider Change Form Only individual health care provider professionals should use this form.
Electronic Funds Transfer (EFT) information is removed from our records when billing addresses and/or tax ID numbers
are changed. Use the EFT form which is located above to initiate EFT for a new address and/or tax ID number.
Additional Provider Office Location Form
The Additional Office Location Form is used when a provider (facilities excluded) wants to add another office location under the same tax identification number.
Facility Change Form
Electronic Funds Transfer (EFT) information is removed from our records when billing addresses and/or tax ID numbers
are changed. Use the EFT form which is located above to initiate EFT for a new address and/or tax ID number.
Facility Update Form
The Facility Update Form is used ONLY upon request. Facilities WILL NOT utilize this form unless specifically requested by the Provider Relations Division.
Use these forms to request certification of the specified medical care for your
patients who have HealthChoice. Penalties are applicable for services that are
not certified.
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