September 2021

ClaimsXten™ Quarterly Update Reminder™

Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement its fourth quarter code updates for the ClaimsXten auditing tool on or after Dec. 13, 2021.

Obesity and Morbid Obesity

Obesity is a chronic, progressive disease. Accurately and completely coding and documenting obesity and morbid obesity can help identify and address related comorbidities that may impact our members’ overall health status

Availity® Claim Status Response Enhancement for Medicare Advantage Claims

The Availity Claim Status tool provides enhanced, real-time claim status details to help you manage and resolve your Blue Cross and Blue Shield of Oklahoma (BCBSOK) claims online.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Oct. 1, 2021 – Part 1

DRUG LIST CHANGES
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. Your patient(s) may ask you about therapeutic or lower cost alternatives if their medication is affected by one of these changes. Changes effective Oct. 1, 2021 are outlined below.

The Quarterly Pharmacy Changes Part 2 article with more recent coverage additions will also be published closer to the October 1 effective date. 

Drug List Updates (Revisions/Exclusions) – As of Oct. 1, 2021

What Do BCBSOK Members Want from their Health Care Professionals? Part 2

In part 2 of this series we talk about open communication between BCBSOK members and their health care professionals. The Blue Cross and Blue Shield of Oklahoma (BCBSOK) Quality Improvement customer satisfaction survey showed BCBSOK members value open communication with their providers.

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: August Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Updated: Laboratory Panel Billing to Standards and Requirements/Clinical payment and coding policies webpage.
• Posted: Intraoperative Neurophysiology Monitoring (IONM) Coding and Reimbursement Guideline to Standards and Requirements/Clinical payment and coding policies webpage.
• Updated: Prior Authorization/Code Look Up and 2021 Commercial Procedure Code List - Fully Insured - Predetermination, Medical Necessity and Non-Covered Services to Claims and Eligibility/ Utilization management 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.

Availity is a trademark of Availity, L.L.C., a separate ‭company that operates a health information network to ‭provide electronic information exchange services to ‭medical professionals. Availity provides administrative ‭services to BCBSIL. 

BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.

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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