Provider/Practitioner Changes

For all changes and/or updates, please refer to the Instruction Guide before submitting any of the below forms.

• Please see the Instruction Guide PDF
• Provider Change Form (PDF) - Any changes in address, telephone and fax numbers, NPI numbers, and provider status (moved out of area, retiring, capacity changes, etc.) must be communicated to Oklahoma Complete Health through this form.
• Provider Profile Sheet (PDF) - Alternative to the Preferred Roster. For practitioners who are already registered with CAQH ProView, additions may be submitted using the Provider Profile Sheet.
  • If you are not registered with CAQH ProView, please complete the registration process on the CAQH ProView website.This is an external link that will take you outside the Oklahoma Complete Health website.
• Fillable W-9 form (PDF)