May 2023

What You Need to Know about the Health Information Exchange

Learn how the Health Information Exchange (HIE) can benefit you as a provider.

BlueApprovR^SM Expedites Medical, Surgical, Pharmacy, Behavioral Health Prior Authorization — Attend a Training

Do you spend too much time waiting on prior authorizations? BlueApprovR can help.

Prior Authorization Codes Updated for Commercial Members, Effective July 1, also watch for Medical Oncology Portal Enhancements

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

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

See the updated CPT codes for Medicare members.

Behavioral Health Consultations During Hospitalization Can Improve Outcomes

Behavioral health consultants during a hospital stay can decrease likelihood of readmittance.

Track Care Visits During and After Pregnancy

Timely prenatal and postpartum care visits can greatly impact health outcomes for both mothers and their infants.

Health Insurance for American Indians and Alaska Natives

Learn how you can help American Indians and Alaska Natives patients access quality, affordable health insurance.

Pharmacy Program Quarterly Update — Changes Effective April 1, 2023 — Part 2

Here is the second part to the Pharmacy Program Quarterly Update.

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: April 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. 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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