July 2021

BCBSOK Pauses Medicaid Implementation

On June 1, 2021, the Oklahoma Supreme Court invalidated the Oklahoma Healthcare Authority's (OHCA's) implementation of the new Medicaid Managed Care Program, Sooner Select. As a result of the Court's decision, OHCA terminated its agreement with Blue Cross and Blue Shield of Oklahoma (BCBSOK) on June 4.

Therefore, BCBSOK is unable to execute any additional BlueSooner^SM provider agreements. All signed BlueSooner contracts have now been terminated per the contract section 7.4 Termination of the OHCA Contract: This BlueSooner Network Agreement shall terminate automatically upon termination of the OHCA Contract.

If you have questions, please email BCBSOKMedicaidNetworkManagement@bcbsok.com or call 1-866-634-5542 and a Medicaid team member will respond to you as quickly as possible.

Closing Gaps in Care for Group Medicare Advantage (MA) Members

The Blue Cross and Blue Shield (BCBS) National Coordination of Care program is again serving Blue Cross Group Medicare Advantage (PPO)^SM (Group MA PPO) members.

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Commercial Members

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements that may apply to some commercial members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Supporting Mental Health

Mental health conditions are common, affecting people of all ages. The Centers for Disease Control and Prevention (CDC) estimates that half of Americans will be diagnosed with a mental illness or disorder at some point in their lives.

Earn CME/CEU Credit at Free Webinar on Opioid Use

Join our board-certified psychiatrists and behavioral health medical directors for a one-hour webinar on opioid use disorder. The webinar is on Wednesday, Aug. 18, 2021, at 8 a.m. Central time. It's free to providers.

Have Questions about Your BCBSOK Contract?

We can help
Blue Cross and Blue Shield of Oklahoma (BCBSOK) provider network representatives serve as the liaison between BCBSOK and our contracted provider community. Developing and maintaining cooperative working relationships with our physicians and other health care providers throughout Oklahoma is our focus.

BCBSOK Provider Network Representatives can assist with:

• Helping ensure compliance with your provider contract.
• Making you aware of BCBSOK educational services and resources.
• Keeping you informed about BCBSOK products, services, programs and initiatives, such as the ICD-10 transition.

If you have questions concerning your provider contract, please reach out to the appropriate area for the quickest and most accurate response.

Professional Provider Contracts

Email: OKNetworkManagement@bcbsok.com
or call the Provider Contract Support Unit at 800-722-3730, Option 2.
Website:Provider Network Representatives

Medicare Contracts

Email: OklahomaMedicareAdvantageNetwork@bcbsok.com
or call the Provider Contract Support Unit at 800-722-3730, Option 2.
Website: Medicare Advantage Prior Authorization Contact Sheet

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: June Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Pharmacy Program UpdatesQuarterly Pharmacy Changes Effective July 1, 2021 – Part 2 to 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.

Blue Cross^®, Blue Shield^® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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.

bcbsok.com/provider

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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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