March 2023

CPT Category II Codes Can Help Close Care Gaps

BCBSOK has begun to allow reimbursement for the CPT II: 0503F.

BlueApprovR^SM Expedites some Prior Authorizations — Attend a Training Soon to Learn More

The launch of BlueApprovR will streamline the prior authorization process and expedite approvals for some behavioral health services.

Cultural Awareness Webinars: Earn Continuing Education Credit

BCBSOK will offer a number of continuing education credit cultural awareness webinars at no cost.

Quality Care: Screening for Depression

Watch a video about screening patients for depression, and read tips for closing gaps in care.

Closing Gaps in Colon Care

Regular screenings today can help your patients avoid potential health risks in the future.

Verify Your Directory Details Every 90 Days

Don’t forget to verify your directory details every 90 days.

Survey to Assess Medicare Advantage Members’ Experiences

This CAHPS survey helps identify ways to improve member service.

Pharmacy Program Updates: Quarterly Pharmacy Changes Effective April 1, 2023 – Part 1

These Quarterly Pharmacy Changes Part I are effective April 1.

Help Close Gaps in Care for Group Medicare Advantage Members

If we need medical records for Blue Cross Group Medicare Advantage (PPO)^SM members, you will receive requests from Blue Cross and Blue Shield of Oklahoma (BCBSOK) or our vendor, Change Healthcare, as part of the Blue Cross and Blue Shield (BCBS) National Coordination of Care program. Please respond quickly to our requests, including requests related to risk adjustment gaps and Healthcare Effectiveness Data and Information Set (HEDIS^®) measures. Learn more.

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: February Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: CPT Category II Codes Can Help Close Care Gaps to Education and Reference Center/News and Updates webpage.
• Posted: Quality Care: Screening for Depression to Education and Reference Center/News and Updates webpage.
• Posted: Closing Gaps in Colon Care 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. 

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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