December 2021
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 Blue Cross and Blue Shield of Oklahoma (BCBSOK) or AIM Specialty Health® (AIM) for only fully insured members.
You can find the tool under the Utilization Management section on our website. The tool includes three categories:
Medical Procedure
- Such as, surgeries, transplants, imaging, and other tests.
Medical Drugs
- Medical prescriptions that you may be taking.
Behavioral Service
- Mental health, psychological testing, and psychiatric care.
Need to Know:
Procedures or services that may be eligible for a predetermination are not included in this tool.
Also, searches are restricted to their own category. For example, using the tool to search in the Medical Procedure category will not reflect Medical Drugs or Behavioral Service prior authorizations.
A few reminders:
- This Prior Authorization Look Up Tool is not exhaustive. Providers must always check eligibility and benefits first using the Availity® Provider Portal or preferred vendor before rendering services to determine prior authorization requirements and utilization management vendor information, if applicable.
- While not included in this Look Up tool, the following always require prior authorization: Inpatient Facility Admissions and Transfers, Private Duty Nursing, Home Health / Hospice Care, Home Infusion Therapies, Home Hemodialysis, Transplant Evaluation and Transplants, and some outpatient therapies and Durable Medical Equipment that costs over benefit limits.
- Refer to the Medical Policies section on our website for more information about specific procedures and services.
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.
AIM Specialty Health is an independent medical benefits management company that provides utilization management services for BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as AIM Specialty Health.