OCAs Integrations Request Form

Integrations Request Form

Thank you for your request. Once this form is submitted an OCA representative will be in contact with your vendor to discuss the next steps.

Prior to completing this form please be sure that you have your vendor contact information and have spoken to your vendor to make them aware that OCA will be contacting them. OCA will not be able to process the integration request without this information.

Please do not complete this form if you are requesting an integration with either Employee Navigator or Ease. All Employee Navigator and Ease requests must come directly through Employee Navigator or Ease.

Employer Name*

Employer name/DBA with OCA

Is this employer new or an existing client to OCA?*

New ClientExisting Client

New Client Notice

Please note that your integration request will not be processed until OCA has received the employer new group application.

Person Requesting Integration *

Your Email*

example@example.com

Your Phone Number

Please indicate which OCA lines of service you wish to integrate with?*

Purpose of the file feed (please select all that apply)*

Eligibility FilesClaims FilesOther

"Vendor" name that will be sending/receiving files?*

.

Vendor Point of contact

First NameLast Name

Vendor Email*

example@example.com

Phone Number

Requested "Go Live" Date of File Connection*

Date

Status

Integration Requested/Not Started

OCA Team

Email

example@example.com