March 2022

Verify and Update Your Information Online via Availity^® Provider Data Management

The Availity Provider Data Management (PDM) tool offers professional providers a quick and easy way to update, validate, and attest to the accuracy of their information on file with Blue Cross and Blue Shield of Oklahoma (BCBSOK).

New Laboratory Management Program to Begin May 1, 2022

Effective May 1, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement its new program with Avalon for claims for certain outpatient laboratory services provided to many of our commercial members.

Reminder: Claim Editing Enhancements Coming April 1

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.

Closing Gaps in Care for Group Medicare Advantage Members

Through the Blue Cross and Blue Shield (BCBS) National Coordination of Care program, we can work with you to help close gaps in care for Blue Cross Group Medicare Advantage (PPO)^SM (Group MA PPO) members. These include Blue Cross and Blue Shield of Oklahoma (BCBSOK) members with Group MA PPO coverage, as well as Group MA PPO members enrolled in other Blue Cross and Blue Shield (BCBS) plans who are living in Oklahoma.

All Contracted Providers Will Now Display in Provider Finder^®

In November, we told you about the Consolidated Appropriations Act (CAA) of 2021 and its requirements for provider directory information. One requirement is that all our contracted providers must be listed in our Provider Finder, including those who chose not to be displayed in the past

Blue Cross and Blue Shield of Oklahoma celebrates 10 years of giving across the state

14 local nonprofit organizations awarded Healthy Kids, Healthy Families^® Grants

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: February Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: ClaimsXten™ Quarterly Update Reminder to the Education and Reference Center/News and Updates webpage.
• Posted: Current Procedural Terminology® (CPT) Codes Updated for Prior Authorization for Medicare to the Education and Reference Center/News and Updates webpage. 
• Posted: Current Procedural Terminology® (CPT) Codes Updated for Prior Authorization for Commercial Members to the 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.

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