March 2021

Telemedicine Expansion for 2021

In support of our members and employer groups during the ongoing national public health emergency (PHE), and in line with the new administration’s information that we expect the PHE to continue for the duration of 2021, we are expanding the telemedicine services we’ll cover through the end of 2021.

CPT Category II Codes Can Help Close Care Gaps

Using the proper Current Procedural Terminology (CPT^®) Category II codes when filing claims can help streamline your administrative processes and ensure gaps in care are closed.

Overpayment Recovery for Multiple Surgical Procedures

Blue Cross and Blue Shield of Oklahoma has identified the need to review claims and past payments for multiple surgical procedures, to ensure alignment with our applicable reimbursement policy.

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).

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

Based on the availability of new prescription medications and Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions (drugs still covered but moved to a higher out-of-pocket payment level) and/or exclusions (drugs no longer covered) will be made to the Blue Cross and Blue Shield of Oklahoma (BCBSOK) drug lists.

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: February Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: The CAHPS^® Survey: We All Play a Role to 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 July impact your reimbursement and your patients’ benefits. You July 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 July 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

ClaimsXten is a software owned by McKesson, an independent company that provides claim management services for Blue Cross and Blue Shield of Oklahoma.

Prime Therapeutics LLC is a separate pharmacy benefit management company contracted by Blue Cross and Blue Shield of Oklahoma to provide pharmacy benefit management and other related services. BCBSOK as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.

File is in portable document format (PDF). To view this file, you July need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe^® Reader^® which has a built-in reader. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com

You are leaving this website/app (“site”). This new site July be offered by a vendor or an independent third party. The site July also contain non-Medicare related information. In addition, some sites July require you to agree to their terms of use and privacy policy.

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

1400 S. Boston, Tulsa, Oklahoma 74119

© Copyright 2021 Health Care Service Corporation. All Rights Reserved.

Legal and Privacy  |  Unsubscribe