April 2021

Some Codes Removed from AIM^® Prior Authorization

On April 1, 2021, Blue Cross and Blue Shield of Oklahoma removed six “Musculoskeletal” codes from the AIM Specialty Health® prior authorization list.

Reminder: eviCore to Manage Commercial Prior Authorization Appeals Process through April 2021 for 2020 Adverse Determinations

As a reminder, for dates of service on or after Jan. 1, 2021, AIM Specialty Health is the utilization management vendor for Blue Cross and Blue Shield of Oklahoma (BCBSOK) commercial Prior Authorization (PA) requests that were formerly handled by eviCore Healthcare^®.

View Professional Provider Fee Schedule via Availity^®

In the March 2021 News and Updates, we announced the upcoming launch of a new electronic Fee Schedule viewer tool via the Availity Provider Portal. This new tool will be available by the end of this month for professional providers participating with BCBSOK.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2021 — Part 2

This article is a continuation of the previously published Quarterly Pharmacy Changes Part 1 article. While that part 1 article included the drug list revisions/exclusions, dispensing limits, utilization management changes and general information on pharmacy benefit program updates, this part 2 version contains the more recent coverage additions, utilization management updates and any other updates to the pharmacy program.

Single Access Point for 835 EFT and ERA Enrollments

Starting May 3, 2021, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will offer a single access point for enrollment in Electronic Funds Transfer (835 EFT) and/or Electronic Remittance Advice (835 ERA) via the Availity^® Provider Portal.

Blue Cross and Blue Shield of Oklahoma awards non-profits across the state

Blue Cross and Blue Shield of Oklahoma (BCBSOK) has selected 15 501(c)(3) organizations to receive grant funding from the Healthy Kids, Healthy Families^® (HKHF) initiative, managed and coordinated by BCBSOK.

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is required by the Center for Medicare and Medicaid Services to contact our providers on a quarterly basis requesting verification of information, such as: provider name, organization name, accepting new patients, street address, phone number, hospital affiliations and other changes that affect availability to patients.

Maintaining accurate provider data and directories are an important part of providing BCBSOK members with the information they need to manage their health. Our online provider directory, Provider Finder^® helps members find in-network doctors and hospitals. The directory is also a helpful tool for you to refer your BCBSOK patients to other participating providers.

Please review your information in Provider Finder to ensure it’s correct. To update your directory information please visit our Information Change Request section on our website. If your information is correct as listed on our website, no further action or response is needed.

Please submit your changes at least 30 days ahead of the effective date. If you have any questions or if you need additional information, please Email provider inquiries or call the Provider Contract Support Unit at 800-722-3730, Option 2.

• Posted: March Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: The Provider Information on COVID-19 to Education and Reference Center/News and Updates.
• Posted: The COVID-19 Vaccines and Coverage Education and Reference Center/News and Updates.

Watch News and Updates for important announcements.

For dates, times and online registration, visit the Provider Training page.

New and revised Current Procedural Terminology (CPT^®) and Healthcare Common Procedure Coding System (HCPCS) codes are periodically added to, or deleted from, the ClaimsXten code auditing tool software by the software vendor on a quarterly basis and are not considered changes to the software version. Blue Cross and Blue Shield of Oklahoma (BCBSOK) will normally load this additional data to the BCBSOK claim processing system after receipt from the software vendor and will confirm the effective date via the News and Updates section of the BCBSOK Provider website. Advance notification of updates to the ClaimsXten software version also will be posted on the BCBSOK Provider website.

To help determine how some coding combinations on a particular claim be evaluated during the claim adjudication process, you continue to use Clear Claim Connection^TM (C3). C3 is a free, online reference tool. Refer to the Clear Claim Connection page on our website for more information on gaining access to C3, as well as answers to frequently asked questions about ClaimsXten. Updates be included in future issues of the Blue Review. Note: C3 does not contain all of the claim edits and processes used by BCBSOK in adjudicating claims, and the results from use of the C3 tool are not a guarantee of the final claim determination.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent company providing coding software to BCBSOK. McKesson Information Solutions, Inc. is solely responsible for the software and all the contents. Contact the vendor directly with any questions about the products, software and services they provide.

The Online Provider Orientation is a convenient and helpful way to learn about the online resources available to you.

Approved new or revised BCBSOK medical policies and their effective dates are posted on the BCBSOK website the first and fifteenth day of each month. These policies impact your reimbursement and your patients’ benefits. You view all active and pending policies or view draft Medical Policies and provide comments. These can be accessed on the Standards and Requirements page of our provider website.

While some information on new or revised medical policies occasionally be published for your convenience, please visit bcbsok.com/provider for access to the most complete and up-to-date information. 

An eRM tutorial is available to show you how to navigate the features of the eRM tool. Log in at your convenience to complete the tutorial and use it as a reference when needed.

Do you have a helpful suggestion or feedback about our website? Fill out our Feedback Survey.

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Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association

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