July 2022

Flex and Open Access for Medicare Patients and Providers

If you’re a Medicare provider, you may treat Blue Cross Medicare Advantage Flex (PPO)^SM and Blue Cross Group Medicare Advantage Open Access (PPO)^SM members, regardless of your contract or network status with Blue Cross and Blue Shield of Oklahoma (BCBSOK).

Catch Up on Routine Vaccines and Well-Child Visits

The COVID-19 pandemic continues to disrupt routine childhood immunizations and well-child visits, according to the Centers for Disease Control and Prevention (CDC). The CDC recommends doctors and health care professionals encourage families to schedule vaccines and visits to help children catch up. We’ve created Wellness Guidelines and vaccine information for our members to help.

Pricing Information to Display Starting in July

As we informed you in October, the Transparency in Coverage Final Rule requires health insurers and some employers to publicly display certain health care price information via machine-readable files on their websites beginning July 1, 2022.

In-home Test Kits for Colorectal Cancer Screening

We’re working with Everlywell to provide in-home test kits this summer to certain Blue Cross and Blue Shield of Oklahoma (BCBSOK) members who need a colorectal cancer screening.

Timeframe Is Returning to Normal for Provider Appeals

In the spring of 2020, the Department of Labor (DOL) issued a notice to health plans and administrators that normal filing periods for appeals or external reviews would be extended through the national emergency (NE). This was implemented and continues to be in effect.

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

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. 

Provider Satisfaction Survey 2022

Building a strong network of providers and working with you to serve our members is important to us. To support this effort we survey a random sample of providers each year.

New Quick Reference Page Available

You asked and we listened! We’ve improved our website by creating a landing page for the most frequently accessed resources on BCBSOK.com/provider.

New Online Option to Confirm Receipt Status of Faxed or Mailed Medical Records

Providers no longer need to contact Blue Cross and Blue Shield of Oklahoma (BCBSOK) to confirm receipt of faxed or mailed medical records for claim processing. We recently implemented a new application in our BCBSOK-branded Payer Spaces section via Availity^® Essentials for you to verify receipt of medical records for claims submitted by mail or fax. This new functionality is just the first iteration of more enhancements coming soon!

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.

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: June Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Update on CT Contrast Shortage to Education and Reference Center/News and Updates 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.

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