December 2022

Statin Therapy for Patients with Cardiovascular Disease and Diabetes

To help monitor and improve our members’ care, we track the quality measures Statin Therapy for Patients with Cardiovascular Disease (SPC) and Statin Therapy for Patients with Diabetes (SPD).

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2023 – Part 1 

The start of a new year is the time for renewed or new health insurance benefits for most Blue Cross and Blue Shield of Oklahoma members. See the Pharmacy Program Updates, effective Jan. 1, 2023.

Prior Authorization Codes Updated for Commercial Members, Effective January 1

Blue Cross and Blue Shield of Oklahoma is changing prior authorization requirements that may apply to some commercial members to reflect new, replaced or removed codes. 

Current Procedural Terminology^® (CPT^®) Codes Updated for Prior Authorization for Medicare, Jan. 1

The start of a new year is the time for renewed or new health insurance benefits for most Blue Cross and Blue Shield of Oklahoma members. See the Pharmacy Program Updates, effective Jan. 1, 2023.

New BCBSOK Network MyBlue HMO^SM Launches Jan. 1, 2023

We are excited to announce that Blue Cross and Blue Shield of Oklahoma (BCBSOK) has created a new network called MyBlue HMO^SM.

New BCBSOK BlueApprovR^SM Tool Improves Behavioral Health Prior Authorization — Attend a Training

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is streamlining the prior authorization process to reduce your workload with the launch of BlueApprovR^SM. This new tool in Availity^® Essentials expedites approvals for Behavioural Health (BH) services for many of our commercial members.

Help Close Gaps in Care for Group Medicare Advantage Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests only from Blue Cross and Blue Shield of Oklahoma (BCBSOK) or our vendor, Change Healthcare. This is part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program so that you won’t receive requests from multiple BCBS plans or their vendors. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures.

Your directory information must be verified every 90 days under a new federal law, even if your data hasn’t changed. Verification of information includes provider name, organization name, accepting new patients, street address, phone number, hospital affiliations and other changes that affect availability to patients.

It’s easy and quick to get it done for all health plans using the Availity^® Essentials Provider Data Management feature. If you’re unable to use Availity, you may use our Demographic Change Form. Facilities may only use the Demographic Change Form to verify and update information. If we haven’t received your verification, look for emails and postcards from us with the checkmark symbol. They’re a friendly reminder that it’s time to verify. Learn more about verifying your data.

• Posted: November Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Downcoding Explanations for NSA Claims by Nonparticipating Providers to Education and Reference Center/News and Updates webpage.
• Posted: Medical Record Status Viewer User Guide to Education and Reference Center/Provider Tools webpage.
• Posted: Consolidated Appropriations Act & Transparency in Coverage Final Rule to Standards and Requirements 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 will 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 are occasionally 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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