November 2022

New Laboratory Management Program to Begin Nov. 1, 2022

Reminder: Effective Nov. 1, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) Implemented its new program with Avalon Healthcare Solutions for certain outpatient laboratory service claims provided to many of our commercial and BlueCard^® (out of area) members.

New BCBSOK Network MyBlue HMO^SM Launches Jan. 1, 2023

We are excited to announce that Blue Cross and Blue Shield of Oklahoma (BCBSOK) has created a new network called MyBlue HMO.

New BCBSOK BlueApprovR^SM Tool Improves Behavioral Health Prior Authorization — Attend a Training

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is streamlining the prior authorization process to reduce your workload with the launch of BlueApprovR. This new tool in Availity^® Essentials expedites approvals for Behavioural Health (BH) services for many of our commercial members.

Prior Authorization Codes Updated for Commercial Members, Effective January 1

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.

New Tool to Verify Credentialing Information

We’re using a new tool to streamline credentialing and verify your data. It’s called VeriFide™ from the Council for Affordable Quality Healthcare® (CAQH). 

Help Close Diabetes Disparity Gaps

Diabetes is one of the most common chronic conditions in the U.S. According to the Centers for Disease Control and Prevention (CDC), more than 37 million Americans of all ages have diabetes

Diabetes Screening for People Using Antipsychotic Medications

People with serious mental illness who use antipsychotic medications are at increased risk of diabetes, according to the National Committee for Quality Assurance (NCQA). Regular screening for diabetes is important for detecting, monitoring and in the treatment of the disease.

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

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. As you see your patients, please consider the following reminders:

Confirm Medical Record Receipt Status Online for Prior Authorization Requests

You can now use the Medical Record Status Viewer to confirm receipt of medical records submitted by fax or mail to Blue Cross and Blue Shield of Oklahoma (BCBSOK) for prior authorization requests.

Submitting Unlisted or Miscellaneous Codes: Billing Guidelines and Reminders

Avoid documentation requests by describing specific drugs, services, supplies or procedures provided when using an unlisted or miscellaneous code.

Current Procedural Terminology (CPT^®) Codes Updated for Prior Authorization for Medicare

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 prior authorization assessment, Current Procedural Terminology (CPT^®) code changes released by the American Medical Association (AMA) or Healthcare Common Procedure Coding System (HCPCS) changes from the Centers for Medicaid & Medicare Services.

Health Equity and Social Determinants of Health: New Resources for Providers

Visit our new Health Equity web page.

Postponed: Use Our Automated Phone System to Request Prior Authorization for FEP^® Members

Blue Cross and Blue Shield of Oklahoma (BCBSOK) has postponed the launch of a new feature to offer prior authorization for Federal Employee Program^® (FEP) members through our interactive voice response (IVR) system.

 Watch News and Updates for future program announcements.

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: October Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Earn Continuing Education Credit at Webinar on Low Back Pain to Education and Reference Center/News and Updates  webpage.
• Posted: Addressing Disparities in Breast Cancer for Black Women  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.

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