April 2023

AIM Specialty Health Changes Its Name to Carelon Medical Benefits Management

Providers will continue to follow their normal processes and use the same phone numbers, web addresses and ProviderPortal as well.

New for 2023: Specialty Pharmacies Added In-Network

Blue Cross and Blue Shield of Oklahoma (BCBSOK) has added Christus Specialty Pharmacy, University Medical Center and Red Chip to its in-network specialty pharmacies.

Supporting Behavioral Health Quality Care

We track quality measures related to behavioral health to help monitor and improve our members’ care. Select the following for information about these measures and tips for closing gaps in our members’ care:

• Prenatal and Postpartum Depression Screening and Follow-Up
• Follow-Up Care for Children Prescribed ADHD Medication
• Initiation and Engagement of Substance Use Disorder Treatment and Follow-up after Emergency Department Visit for Substance Use

Earn Continuing Education Credit through Webinar on Opioids

Join us for a webinar on Synthetic Opioids and the Opioid Crisis on April 24 or 26.

Pharmacy Program Quarterly Update, Part 2: Changes Effective Jan. 1, 2023

Remind your patients how the new drug list could impact their benefits in the new year.

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: March Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Survey to Assess Medical Advantage Members’ Experience to Education and Reference Center/News and Updates webpage.
• Posted: More Access for Medicare Patients and Providers to Education and Reference Center/News and Updates webpage.
• Posted: Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 – Part 1 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. 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 will 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 are occasionally 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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