December 2021

Consolidated Appropriations Act & Transparency in Coverage Final Rule

The Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule will impact many of our members starting Jan. 1, 2022. As providers caring for our members, you may be impacted as well.

Catch Up on Vaccines for All Ages

The COVID-19 pandemic has significantly disrupted routine immunizations for children, adolescents and adults, according to the U.S. Department of Health and Human Services. You may hear from our members about catching up on delayed vaccinations. We’ve created resources for them about staying current on routine vaccines. 

Speaking Out About the ‘Silent Killer’

High blood pressure, or hypertension, is known as a "silent killer"  because it usually has no warning signs. Nearly half of adults in the U.S. have hypertension, according to the Centers for Disease Control and Prevention (CDC) , and only about 1 in 4 of them have the condition under control. Encourage our members to talk with you about their blood pressure  and heart health .

Avoiding Antibiotics for Acute Bronchitis

We track Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)  as part of monitoring and helping improve quality of care. AAB is a Healthcare Effectiveness Data and Information Set (HEDIS^®) measure from the National Committee for Quality Assurance (NCQA). 

Fighting Fraud, Waste and Abuse

Every year analysts and investigators for Blue Cross and Blue Shield of Oklahoma (BCBSOK) review claims data, industry trends and investigative results to identify potential areas of fraud, waste and abuse. 

New Digital Lookup Tool for Fully Insured Members

You are now able to search by 5-digit code, drug name or service description with the new Digital Lookup Tool for Medical, Medical Drugs or Behavioral Services and procedures that may require prior authorization through BCBSOK or AIM Specialty Health^® (AIM) for only fully insured members.

Single Sign-On Access to AIM Specialty Health^® via Availity^®

Checking patient eligibility and benefits is an imperative first step to confirm coverage and prior authorization requirements before rendering services. The Availity Eligibility and Benefits Inquiry allows you to quickly confirm prior authorization requirements, along with contact information for the utilization management vendor, if applicable.

View Withdrawn Claim Descriptions via the Availity^® Claim Status Tool

There may be instances when you receive a claim withdrawn notification by mail after submission to Blue Cross and Blue Shield of Oklahoma (BCBSOK). As an alternative method, you may also determine why a claim was withdrawn via the Availity Claim Status tool response.

The claim status response includes status for original, duplicate, adjusted, replacement, as well as withdrawn claims. Refer to the Custom Status Description field on the results page to determine why the claim was withdrawn. After addressing the reason, the claim may be resubmitted electronically to BCBSOK for processing.  

For assistance with verifying claim status online, refer to the Claim Status User Guide.
This information is not applicable to Medicare Advantage claims.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

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, 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: November Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Room Rate Registration Form to the Education and Reference Center/Forms.
• Updated: Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare to the Education and Reference Center/News and Updates/Blue Review webpage.

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.

CPT copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

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.

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