Medical Credentialing Services in Oklahoma

Julieta Avendano
Image of doctors walking with Oklahoma outline overlayed

Oklahoma’s rural areas drive many of the credentialing differences, which are designed to increase accessibility and service delivery. Oklahoma also integrates unique requirements and checks into its credentialing process, including specific mandates for continuous education and state-specific licensure exams that reflect local health concerns and laws. One of the newest changes that impacts medical credentialing services in Oklahoma is a major change to SoonerCare, the state’s Medicaid program. 

What’s Unique About Medical Credentialing in Oklahoma

While much of the credentialing and payer enrollment processes are the same in Oklahoma as in other states, here are a few things to be aware of:

Transition to SoonerSelect

As of April 1, 2024, the Oklahoma Health Care Authority has transitioned to a new comprehensive service delivery system called SoonerSelect. Three contracted entities (Aetna Better Health of Oklahoma, Humana Health Horizons, and Oklahoma Complete Health) will now deliver services. Credentialing and recredentialing is required through a single, consolidated provider enrollment and credentialing process. 

Controlled Dangerous Substance (CDS) Required

The Oklahoma State Bureau of Narcotics and Dangerous Drugs Control requires registration as well as a controlled dangerous substance (CDS) license. This is in lieu of a DEA license. 

Uniform Credentialing Application

Oklahoma uses a uniform credentialing application, which streamlines the process. Providers or credentialers can easily download a pre-filled application from CAQH — the format changes slightly per payer, but it includes almost the same information as any other “standard” application.  

Steps To Complete Provider Credentialing in Oklahoma

Medical credentialing services in Oklahoma can be too much work for a single person, and without a system that allows them to be on track, it’s even more difficult.

Here are the general steps involved in completing medical credentialing in the state of Oklahoma:

  • Set Up Online Portals. Ensuring the provider’s CAQH profile is up to date, and if the provider will also be enrolling in SoonerCare, Oklahoma’s Medicaid program, you’ll want to ensure the provider has a profile.
  • Primary Source Verification. Primary source verification involves contacting original sources — such as educational institutions, licensing boards, and certification bodies — to confirm the authenticity and accuracy of the documents and qualifications provided by the provider. Payers in Oklahoma have specific requirements.
  • Work History and Reference Checks. To assess the provider’s experience and reputation within the healthcare community, the work history of the provider must be verified without any gaps longer than 30 days. 
  • Background Checks. Comprehensive background checks help rule out any criminal history, malpractice claims, disciplinary actions, or other records that might send up red flags. 
  • Payer Enrollment. Providers must be enrolled with every payer they accept insurance from — again, before they start seeing patients. With an average of 5 – 10 payers per provider, this can be a time-consuming and tedious step that needs to start early in the credentialing process. 
  • Privileging. Privileging involves the collection and review of a provider’s documentation to determine if they’re worthy to provide care to patients within a specific institution. All providers must receive privileges at the facility where they will see patients before they begin practicing. 

Tips To Speed Up Credentialing in Oklahoma

I’ve encountered several unresponsive payers in Oklahoma, so in these cases, a lot of follow-up communication is required — and the process can be substantially longer than the 60-day average. 

The exact timeline depends heavily on the provider’s specialty, volume of providers, and the efficiency and completeness of the provider’s documentation.

1. Start as soon as the provider is hired.

Knowing that you’ll need to diligently follow up with some payers in Oklahoma, make sure you start collecting documents as soon as possible and, if enrolling with Medicaid, create a profile as soon as possible. Credentialing early will also alert you to any red flags or complications early in the hiring and onboarding process. 

2. Make it easy for providers to submit documents.

It is much easier for you and the provider to request digital documents as opposed to collecting a paper credentialing packet. Credentialing software offers the ability for providers to securely submit documents to an online portal. 

3. Request a group roster

If you have at least 10 providers, request a group roster from each payer to quickly gather important information such as effective date, recredentialing date, and lines of business. If you aren’t able to get a group roster, then you’re left to gather this information individually for each provider, from every payer.

4. Set a process specific to Oklahoma’s payers.

Using your organization’s enrollment application data, you should be able to identify the payers who take the longest to respond and plan accordingly. Maybe you set additional reminders to follow up or prioritize completing applications for those payers. You can also be sure to set expectations with your provider and scheduling team that enrollment with specific payers may be delayed. 

5. Set reminders and notifications.

Payers may not let you know the upcoming recredentialing date for your providers, and the date could always be moved earlier if there are internal changes with private payers. It’s important to schedule recredentialing reminders as soon as you complete the credentialing process so you don’t miss a deadline. Reminders are also helpful during the process when there are additional steps required to complete the action. Credentialing software can automate these reminders to ensure you don’t miss steps or deadlines.

View this guide for more tips on speeding up your credentialing process.

Keep Credentialing Organized for Oklahoma Providers 

A long process, with some parts online and some on paper, makes medical credentialing in Oklahoma a challenge. Using medical credentialing services in Oklahoma can help to speed up the process because these credentialing specialists are used to the rules and regulations. In many cases, they have also developed good working relationships with the payers, which can smooth the process. 

Find out how MedTrainer can help — whether you just need software or you’re looking for credentialing services to handle the process for you.