May 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 means you will no longer have to wait until the first day of the following month for your contract to go into effect.

Supporting Care During and After Pregnancy

For pregnant and postpartum women, care visits can set the stage for their and their infants’ long-term well-being, according to the American College of Obstetricians and Gynecologists. We encourage you to discuss timely care with our members during and after pregnancy. Resources that may help include our Preventive Care Guidelines and Perinatal Wellness Guidelines.

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

IMPORTANT PHARMACY BENEFIT REMINDERS 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.

Coding for Breast Augmentation and Removal for Gender Affirming Surgery

The American Medical Association (AMA) recently updated their guidance for the correct Current Procedural Terminology (CPT^®) codes to use when filing claims for breast removal and breast augmentation as part of gender reassignment surgeries.

Current Procedural Terminology^® (CPT) Codes Updated for Prior Authorization for Medicare, Effective July 1

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Credentialing Requirement for Facility-Based Providers

As we told you in May, the Consolidated Appropriations Act (CAA) of 2021 requires that we list all contracted providers in our online directory, Provider Finder^®.

Follow-Up Care for Substance Abuse Disorders

Alcohol-related deaths in the U.S. increased more than 25 percent during the first year of the COVID-19 pandemic, according to a recent report in the Journal of the American Medical Association. We encourage providers to talk with our members about the signs of substance abuse disorder and urge them to seek help, if appropriate.

New ‘Message This Payer’ Option Coming Soon via Availity^® Essentials 

Go DIGITAL and avoid the phone to resolve your claim inquiries online! We will soon launch Message This Payer, a convenient electronic method to send secure messages to Blue Cross and Blue Shield of Oklahoma (BCBSOK) for commercial claim management questions.

Champions of Health Awards Accepting Nominations Through May 20

Nominations are open now through May 20 for the 2022 Champions of Health awards. Since 2004, the Champions of Health awards program has honored those working to positively change the health status of Oklahomans through unique and innovative programs.

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: April Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Updates: Clinical Payment and Coding Policies under the Standards and Requirements section.
• New: 2022 Utilization Management Denials Provider Guide under Related Resources in the Utilization Management section.

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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