Home Health Agency/Private Duty Nursing Provider Contract

The following documents must be filled out and submitted together in order for OHCA to process your enrollment:

Step 1. Print the OHCA Home Health Agency/Private Duty Nursing Provider Contract and fill it out;

Step 2. Include a copy of certification from Medicare or JCAHO;

Step 3. Mail the completed contract with all forms to:

Oklahoma Health Care Authority
ATTN: Provider Enrollment
Post Office Box 54015
Oklahoma City, Oklahoma 73154

Failure to complete and attach all forms, licenses and certifications will delay your contract which could cause delays in your payment.