June 2022

Changes to BCBSOK’s Policy on Provider Network Effective Date

On May 2, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) updated its policy on assigning effective dates to join the networks. This policy enhancement will make it easier for providers to care for BCBSOK members and submit claims in a timely manner.

ClaimsXten™ Quarterly Update Reminder

Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement its third quarter code updates for the ClaimsXten auditing tool on or after August 22, 2022.

These Quarterly code updates aren’t considered changes to the software version. Code updates may include additions, deletions and revisions to:
• Current Procedural Terminology (CPT^®) codes
• Healthcare Common Procedure Coding System (HCPCS) codes

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’ll receive requests only from Blue Cross and Blue Shield of Oklahoma (BCBSOK) or our vendor, Change Healthcare.

Availity^® Essentials Claim Status Tool Update

Your Availity Administrator must add the NPI number to Manage My Organization located in My Account Dashboard on the Availity Essentials home page. That will ensure your information is in the "Select a Provider" drop-down list in the Claim Status tool to populate in Member and Claim number search options.

Submit Multiple Clinical Claim Appeal Requests Online

Starting on May 22, 2022, providers will have the option to electronically initiate one clinical claim appeal request for multiple claims when it is for the same patient and denial reason using the Availity^® Claim Status tool.

Managing Diabetes

More than 37 million Americans have diabetes, according to the Centers for Disease Control and Prevention (CDC). Because symptoms can develop slowly, one in five don’t know they have it. You may play an important role in supporting our members through regular screenings, tests and office visits.

Behavioral Health Collaboration Requests

If you provide behavioral health services to our members, you may receive a request to collaborate with us as part of our Behavioral Health Case Management program.

Education Information Required for Directory

The Blue Cross and Blue Shield Association requires that we collect medical school and residency information from physicians (MDs and DOs) who participate in Blue Cross and Blue Shield of Oklahoma (BCBSOK) networks. Please respond promptly if you receive a request from us for this information.

Earn Continuing Education Credit at Webinar on Avoiding Inappropriate Antibiotic Use

Free webinar on preventing antibiotics overuse on June 29, 2022, from 12:15 to 1:15 p.m. CT. Doctors (MDs and DOs), physician assistants and nurse practitioners will earn one continuing medical education (CME) credit for attending.

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: May Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Update: Electronic Clinical Claim Appeal Request User Guide under the Education and Reference Center/Provider Tools/ Electronic Clinical Claim Appeal Requests via Availity
• Updated Clinical Payment and Coding Policies under the Standards and Requirements

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.