August 2023

Physician Performance Insight Reports are Now Available

These reports help compare performance with your peers and provide important feedback.

Webinar on Coding for Morbid and Severe Obesity

Join us for a free webinar on coding for morbid and severe obesity. The webinar includes coding information from the Official ICD-10-CM Coding Guidelines.

Medicare Providers May Treat Medicare Advantage Flex and Group Medicare Advantage Open Access PPO Members

Don’t miss this note if you treat these Blue Cross and Blue Shield of Oklahoma Medicare members.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023

Check out part 2 of the Pharmacy Program Quarterly Update for the third quarter.

Prior Authorization Codes Updated for Commercial Members, Effective Oct. 1, 2023

Stay updated on the latest prior authorization requirement that could impact commercial patients.

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

See the latest CPT codes for Medicare members.

Claim Editing Changes for Professional Emergency Department Services Coming Nov. 1, 2023

These enhancements focus on evaluation and management (E&M) services billed to our commercial members.

In-Home Test Kits for Colorectal Cancer Screening

These testing kits provide an efficient method for colorectal cancer screening.

Helpful Tips: Utilizing the Carelon Provider Portal

Here are some helpful hints when utilizing the Carelon Medical Benefits Management (formerly AIM Specialty Health) Provider Portal.

Statin Therapy for Patients with Cardiovascular Disease and Diabetes

These guidelines are important for your patients in following their medications.

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.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

• Posted: July Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: Catch Up on Routine Vaccines and Well-Child Visits to Education and Reference Center/News and Updates webpage.
• Posted: New Availity Eligibility & Benefits Experience to Education and Reference Center/News and Updates webpage.
• Posted: Preparing for 2023 Summer HEDIS Medical Record Collection 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 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. 

New or revised BCBSOK clinical payment and coding policies can be found on the BCBSOK website. These policies provide billing, coding, and documentation guidelines that you may find useful in your practice or facility. Please visit this site regularly to ensure you are up to date on any changes or new policies.  These policies can be accessed on the Clinical Payment and Coding Policies page of our website.

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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