Medical Billing Services in Oklahoma.
Oklahoma’s healthcare landscape changed dramatically in 2024 with the April 1 launch of SoonerSelect—the state’s first managed Medicaid program in 20 years, replacing the former Primary Care Case Management system. After SoonerCare’s original managed care experiment collapsed in 2004 when providers mass-dropped out, and after the Oklahoma Supreme Court blocked a second attempt in 2021, SoonerSelect finally launched with three MCOs serving most of the state’s 1.04 million Medicaid enrollees. Happy Billing guides Oklahoma providers through SoonerSelect MCO credentialing, prior authorization, claims routing, and the critical transition from legacy SoonerCare FFS billing to MCO-based workflows.
Oklahoma Medicaid (SoonerCare) Billing
SoonerCare covers approximately 1.04 million Oklahomans as of early 2025—about 25% of the state’s population—down from a COVID-era peak of 1.36 million in January 2023. Oklahoma expanded Medicaid via a June 2020 ballot initiative (effective July 2021), bringing coverage to over 330,000 additional adults at or below 138% FPL. SoonerSelect managed care launched April 1, 2024 for most members, with the aged, blind, and disabled (ABD) population retained in SoonerCare Traditional FFS.
SoonerSelect MCOs (Launched April 1, 2024)
Three health plans serve SoonerSelect-enrolled members across the state:
- Aetna Better Health of Oklahoma (CVS Health): One of three SoonerSelect Contracted Entities (CEs); national Medicaid managed care experience with Oklahoma-specific provider networks
- Humana Healthy Horizons in Oklahoma: Humana’s Medicaid division; covers SoonerSelect members statewide with care coordination and value-added benefits
- Oklahoma Complete Health (Centene): Centene subsidiary; largest Medicaid managed care operator nationally; Oklahoma market presence through its subsidiary network
SoonerSelect Dental Plans
- DentaQuest: One of two contracted dental plans for SoonerSelect members
- LIBERTY Dental Plan of Oklahoma: Second dental plan option; dental enrollment opened February 2024, ahead of medical plan enrollment
SoonerCare Traditional (FFS — Retained Populations)
The following populations remain in fee-for-service SoonerCare Traditional and are NOT enrolled in SoonerSelect managed care:
- Aged, Blind, and Disabled (ABD) populations: Seniors 65+, individuals receiving SSI/SSDI, and those with qualifying disabilities remain in FFS
- ADvantage Waiver participants: Home and Community-Based Services waiver enrollees serving adults aged 65+ and adults with physical disabilities
- American Indian/Alaska Native members: May opt in to SoonerSelect but retain the right to remain in SoonerCare Traditional FFS
- Children in foster care and juvenile justice: Managed under separate arrangements
- In-Home Support Waiver members and other HCBS waiver populations
Key Billing Facts for Oklahoma Providers
- MCO selection: Members had open enrollment Feb 1–March 10, 2024; non-choosers auto-assigned; annual open enrollment each year thereafter
- Continuity of care: SoonerSelect requires 90-day continuity of care period—existing patients could continue with out-of-network providers through June 2024 during transition
- Dental separate: Dental claims route to DentaQuest or LIBERTY Dental, not the medical MCO
- SoonerCare Traditional billing: ABD and retained populations billed FFS through OHCA’s Medicaid Management Information System
- SoonerCare Helpline: 1-800-987-7767 for member and provider inquiries
- Provider enrollment: Oklahoma Health Care Authority (OHCA) at oklahoma.gov/ohca for FFS enrollment; credential separately with each SoonerSelect MCO
Oklahoma's Major Health Systems
Saint Francis Health System
Tulsa-based Saint Francis Health System is Oklahoma’s largest health system by net patient revenue at $2 billion NPR, and is ranked #1 hospital in Oklahoma by U.S. News & World Report. The system operates Saint Francis Hospital (the flagship 974-bed tertiary care center), Saint Francis Hospital South, Warren Clinic (150+ clinic locations throughout eastern Oklahoma), and a broad network of specialty services. Saint Francis serves as a key SoonerSelect network anchor in northeastern Oklahoma and maintains the region’s largest employed physician group through Warren Clinic.
INTEGRIS Health
Oklahoma City-based INTEGRIS Health is Oklahoma’s largest Oklahoma-owned nonprofit health system with 16 hospitals and NPR of $1.8 billion. The flagship INTEGRIS Baptist Medical Center is the largest hospital in Oklahoma City and one of the state’s premier tertiary care hospitals. INTEGRIS operates a statewide network spanning rural, community, and tertiary hospitals from the Panhandle to southeastern Oklahoma, making it the dominant health system across central and western Oklahoma. INTEGRIS is a critical SoonerSelect network participant in the Oklahoma City metro market.
OU Health (University of Oklahoma Health Sciences Center)
The University of Oklahoma’s academic health system serves as Oklahoma’s sole comprehensive academic medical center with NPR of $1.6 billion. OU Medical Center is Oklahoma’s only Level I Trauma Center, the state’s only comprehensive cancer center (Stephenson Cancer Center), and home to the region’s only comprehensive stroke program. As the teaching hospital for the OU College of Medicine—the state’s only allopathic medical school—OU Health serves a disproportionate share of the state’s most complex and uninsured patients. OU Medical Center is in-network with all three SoonerSelect plans, making it a critical destination for managed Medicaid referrals statewide.
Mercy Hospital Oklahoma City
CommonSpirit/Mercy operates a significant Oklahoma City campus with 349 beds and Level III trauma designation, providing Catholic nonprofit hospital care as an alternative to INTEGRIS and OU Health in central Oklahoma. Mercy’s Oklahoma network also includes facilities in Ardmore and Edmond, covering central and south-central Oklahoma’s commercial and Medicaid populations.
Specialties We Serve in Oklahoma
Each specialty page dives into the specific billing challenges and our approach. Visit our Specialties to explore the one most relevant to your practice.
Why Oklahoma Practices Choose Happy Billing
SoonerSelect’s April 2024 launch created an immediate and complex billing transition for the thousands of Oklahoma providers who previously billed SoonerCare FFS directly through OHCA. Overnight, most Medicaid patients shifted to one of three MCOs—each with distinct prior authorization requirements, credentialing processes, formularies, and claims portals. Providers who failed to credential with all three MCOs risked losing access to the entire Medicaid expansion population. Happy Billing managed Oklahoma clients through this transition: credentialing with Aetna Better Health, Humana Healthy Horizons, and Oklahoma Complete Health simultaneously; mapping legacy FFS billing workflows to MCO-specific protocols; and managing the 90-day continuity of care billing window. We now provide ongoing SoonerSelect MCO billing management alongside SoonerCare Traditional FFS billing for ABD populations.
- SoonerSelect MCO billing for all three health plans (Aetna Better Health, Humana, Oklahoma Complete Health)
- SoonerCare Traditional FFS billing for ABD, ADvantage Waiver, and retained populations
- Saint Francis, INTEGRIS, and OU Health network credentialing
- DentaQuest and LIBERTY Dental separate billing management
- Rural health clinic and Critical Access Hospital billing expertise for Oklahoma’s rural providers
Oklahoma Medical Billing FAQs
What is SoonerSelect and how does it differ from legacy SoonerCare?
SoonerSelect is Oklahoma’s capitated Medicaid managed care program launched April 1, 2024. Unlike the previous SoonerCare Choice Primary Care Case Management system—where OHCA paid providers FFS directly and PCPs served as care coordinators without financial risk—SoonerSelect contracts with three MCOs (Aetna Better Health, Humana Healthy Horizons, Oklahoma Complete Health) who receive per-member per-month capitation payments and pay providers through their own claims systems. Providers must now credential with each MCO separately and follow each plan’s prior authorization, claims submission, and appeal procedures rather than a single OHCA FFS process.