January 2022

Hospitals must Provide Medicare Outpatient Observation Notice

Hospitals and Critical Access Hospitals (CAH) are required to give the standardized Medicare Outpatient Observation Notice (MOON) to our Blue Cross Medicare Advantage^SM members who are under outpatient observation for more than 24 hours.

New Flexible Medicare Advantage PPO Plan

We’re offering certain Blue Cross Medicare Advantage^SM members a new way to access care. The Blue Cross Medicare Advantage Flex (PPO)^SM Plan is an open access plan. 

Claim Editing Enhancements Coming April 1, 2022

Effective April 1, 2022, 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. 

Reminder: Claim Editing Enhancements Coming in 2022, Register for a Training Webinar

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.

Current Procedural Terminology (CPT^®) Codes Updated, including Cardiology, 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). A summary of changes is included below.

Chiropractic & Mixed Therapy Benefits Contained in IVR Phone System as of Jan. 3, 2022

Beginning Jan. 3, 2022, the option to speak to a Customer Advocate will be removed for the chiropractic and mixed therapy benefit category within our automated Interactive Voice Response (IVR) phone system.

It’s Time - Verify Your Directory Details

In November, we told you about the Consolidated Appropriations Act (CAA) requirement that certain provider directory information be verified every 90 days. This requirement is effective as of Jan. 1, 2022.

What This Means for You
As of Jan. 1, you must:

• Verify your name, address, phone, specialty and website for our Provider Finder^® every 90 days
• Update your information when it changes, including if you come in or go out of a network

Under CAA, we are required to remove providers from Provider Finder whose data we are unable to verify. In addition, if you leave a network, you should update your directory information immediately. If you are incorrectly identified as an in-network provider, it may limit member cost-sharing to in-network levels.

How to Verify and Update
We recommend you use the Availity^® Provider Data Management feature to quickly verify and update your information with us and other insurers every 90 days. If you are unable to use Availity, you may submit a Demographic Change Form.

Note: Ancillary and facility providers should only use the Demographic Change Form to verify and update their data.

We won’t accept demographic changes by email, phone or fax to enable us to meet the two-day update requirement defined by CAA. Any demographic updates requested through these channels will be rejected and closed.

To apply to join our networks or add a provider to your current group, see How to Join.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

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: December Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2022 – Part 1
• Posted: Previous announcement: New Laboratory Policies Coming Jan. 1, 2022 - Delayed to Education and Reference Center/News and Updates webpage.
• Updates: Clinical Payment and Coding Policies to Standards and Requirements webpage. 
• Update: Blue Cross Medicare Advantage^SM Plans section of the 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.

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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