October 2021

Remember: Use AIM for Prior Authorization - Coming for Pharmacy Medical Oncology

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements that may apply to some commercial members.

Breast Cancer Screening

Breast cancer is the second leading cause of death among women in the U.S., according to the Centers for Disease Control and Prevention (CDC) . About 1 in 8 women will get breast cancer at some point in her life. We encourage providers to talk with our members about the importance of regular screenings for women. We’ve created some resources that may help.

Managing Diabetes

More than 34 million Americans – just over one in 10 – have diabetes, according to the Centers for Disease Control and Prevention (CDC). Because symptoms can develop slowly, one in five don’t know they have it. We encourage providers to talk with our members about diabetes.

Access Standards for Behavioral Health Providers

When it comes to our members and their mental health, it’s important they have access to care when and where they need it. All contracted providers for Blue Cross and Blue Shield of Oklahoma (BCBSOK) must comply with BCBSOK quality standards, including those relating to members’ access to care.

What Do BCBSOK Members Want from their Health Care Professionals? Part 3

In part 3 of this series we discuss ways to increase engagement between BCBSOK members and their health care professionals after their appointments. The Quality Improvement customer satisfaction survey indicated BCBSOK members appreciate having time to discuss next steps and follow-ups after their appointments.

The APRN (CNP and CNS) Credentialing Requirements

Blue Cross and Blue Shield of Oklahoma (BCBSOK)’s credentialing process follows the national Consensus Model for Advanced Practice Registered Nursing (APRN) (Certified Nurse Practitioner (CNP) and Certified Nurse Specialist (CNS): Licensure, Accreditation, Certification and Education.

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: September Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Change to Some Primary and Secondary Claims Coordination to Education and Reference Center/News and Updates.
• Posted: Remember: Use AIM for Prior Authorization - Coming for Pharmacy Medical Oncology to education and Reference Center/News and Updates.
• Posted: ClaimsXtenTM Quarterly Update Reminder 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.

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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