April 2022

Supporting Mental Health

More than half of Americans will be diagnosed with a mental illness or disorder at some point in their lives, according to the Centers for Disease Control and Prevention. We encourage providers to talk with our members about mental health and getting help if needed. A depression screening tool can help with this conversation.

ClaimsXten™ Quarterly Update Reminder

Effective May 1, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial members.

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). A summary of changes is included below.

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).

Advisory on Telemedicine Services – Place of Service (POS) Codes

Blue Cross and Blue Shield of Oklahoma (BCBSOK) has updated its telemedicine commercial reimbursement guidelines due to recent updates by the Centers for Medicare & Medicaid Services (CMS).

Closing Gaps in Colon Care

Screening is the most effective way to reduce the risk of colorectal cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC and the U.S. Preventive Services Task Force (USPSTF) recommend that everyone 45 to 75 years old get a screening. We encourage you to discuss screening and colon health with our members. We’ve created resources that may help.

Free Webinars and Continuing Education Credit 

Join us for free one-hour webinars in April and May 2022. Each webinar provides one continuing medical education (CME) credit or continuing education unit (CEU). Registration is required.

Four High School Seniors Receive Scholarships at Oklahoma Youth Expo

On March 17, Blue Cross and Blue Shield of Oklahoma (BCBSOK) awarded four-$5,000 health and wellness scholarships to a selection of high school seniors who participated in the Oklahoma Youth Expo. Scholarship winners include Kate Dillon of Mustang, Josie Hayes of Miami, Macy Koch of Perry, and KayLea Taylor of Mulhall-Orlando.

Champions of Health Awards Accepting Nominations Starting April 20

Nominations will be accepted starting April 20 through May 20 for the 2022 Champions of Health awards.

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.

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: March Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Updates: Clinical Payment and Coding Policies under the Standards and Requirements section.

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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