Blue Review – June 2023  |  view in Web Browser

June 2023

News & Updates

Coverage for Telemedicine Services since the Public Health Emergency Ended May 11

Make sure to see the response from Blue Cross and Blue Shield of Oklahoma (BCBSOK) to the end of the COVID-19 Public Health Emergency.

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PEAQSM Provider Performance Insights (PPIs)

PEAQ Provider Performance Insights (PPIs) are coming soon. The PEAQ program evaluates physician performance in a transparent and multidimensional way. PEAQ data informs member steerage and can impact network optimization and employer insights. Reports show how providers compare to peers and include info to improve future performance.

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Medicare Advantage Annual Wellness Visit: Resources

Here are some resources to help you fulfill your Medicare wellness visits requirements.

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Medical Records Reminder for Out-of-Area Medicare Advantage Members

BCBSOK or Change Healthcare will send out requests if we need medical records for Blue Cross Group Medicare Advantage (PPO)SM members.

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BlueApprovRSM Expedites Medical, Surgical, Pharmacy, Behavioral Health Prior Authorization — Attend a Training

Tired of waiting on prior authorizations? Let BlueApprovR help you.

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Members can now access network of pharmacies at accredited cystic fibrosis treatment centers

Pharmacies with accredited cystic fibrosis treatment centers have been added to the Prime Therapeutics’ IntegratedRx™ network.

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ClaimsXten™ Quarterly Update Effective August 21, 2023, New Software Version Coming

Please be aware of upcoming code updates as well as a software upgrade.

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Helping Our Members Manage Diabetes

You play a critical role - check out these resources that can help your patients keep their numbers in check.

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

Don’t miss part 1 of the Pharmacy Program Quarterly Update for the third quarter.

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

Please note changes to both ultrasound and Specialty Drug codes.

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Prior Authorization Codes Updated for Commercial Members, Effective July 1

Don’t miss updates to Medical Oncology codes.

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Provider Data and Directory Updates

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.

Web Changes

Stay informed!

Watch News and Updates for important announcements.

Provider Training

For dates, times and online registration, visit the Provider Training page.

ClaimsXtenTM Quarterly Updates

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 ConnectionTM (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.

BCBSOK Online Provider Orientation

The Online Provider Orientation is a convenient and helpful way to learn about the online resources available to you.

Medical Policy Reminder

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. 

Clinical Payment and Coding Policies Reminder

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.

On-Demand Training

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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