February 2022

ClaimsXten™ Quarterly Update Reminder

Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement its first quarter code updates for the ClaimsXten auditing tool on or after April 11, 2022.

Supporting Healthy Hearts

Heart disease and stroke are among the leading causes of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). We encourage you to talk with our members about reducing and managing risks. We’ve created resources that may help, including information on high blood pressure and cholesterol.

Health Insurance for American Indians and Alaska Natives

The Affordable Care Act (ACA) is a law that changed the way people can get individual health insurance. People who don't have insurance through work can buy it on the Health Insurance Marketplace.

Availity^® Tools to Support Providers in 2022

In October we highlighted changes starting Jan. 1, 2022, for the Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule. To further support you, the Availity Provider Portal helps providers and Blue Cross and Blue Shield of Oklahoma (BCBSOK) quickly and securely share information, including information defined by the CAA.

Reminder: Claim Editing Enhancements Coming

As we recently announced, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will enhance our claims editing and review process with Cotiviti, Inc., for some of our commercial members to help ensure accurate coding of services and that services are properly reimbursed.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 1

PHARMACY NETWORK CHANGES Some Blue Cross and Blue Shield of Oklahoma (BCBSOK) members’ plans may have experienced changes to the pharmacy network as of Jan. 1, 2022. Some members’ plans may have moved to a new pharmacy network and some members’ plans may experience changes to the pharmacies participating within the network.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 2

Jan. 1, 2022 is the start of a new year and renewed or new health insurance benefits for most Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. Some members’ plans may have moved to a new pharmacy network and some members’ plans may experience changes to the pharmacies participating within the network.

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: January Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Updated: Clinical Payment and Coding policies to the Standards and Requirements
• Update: Blue Cross Medicare Advantage Plans webpage to the Network Participation
• Updated Provider Information on COVID-19 Coverage webpage under the 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.

Do you have a helpful suggestion or feedback about our website? Fill out our Feedback Survey.