BLUE REVIEW^SM

November 2023

MyBlue HMO^SM Frequently Asked Questions

On Jan. 1, 2023, Blue Cross and Blue Shield of Oklahoma created a new network called MyBlue HMO.

What are some requirements of the MyBlue HMO Member Health Plan?

• MyBlue HMO Members must choose a Primary Care Provider* who is participating in the MyBlue HMO network.
• The MyBlue HMO PCP must submit referrals for specialists, hospitals and other providers to BCBSOK.
• Behavioral health providers do not require a referral from the MyBlue HMO PCP for outpatient services.
• MyBlue HMO Members do not have coverage for services provided by out-of-network providers except for true emergencies.

*The PCP can be a family practitioner, pediatrician, internist, or physician assistant or advanced practice nurse in one of those areas of practice.

The MyBlue HMO PCP can be an independent provider or one from the following provider groups:

The following hospitals can be used with a referral from MyBlue HMO Member’s PCP through BCBSOK in addition to the MyBlue HMO Member’s specialist:

How can I identify MyBlue HMO Members?

MyBlue HMO Members are identified by the following on their BCBSOK ID card:

• MyBlue HMO is displayed on the Member ID card or Dependent ID card.
• MyBlue HMO Members have a unique network ID: BAV.
• The MyBlue HMO Member’s assigned PCP is displayed on the Member ID card.
• The 3-character prefix is: K2G.

How can I identify a MyBlue HMO Member from a BlueLincs HMO^SM Member?

BlueLincs HMO Members are identified by the following on their BCBSOK ID card:

• BlueLincs HMO is displayed on the Member ID card or Dependent ID card.
• BlueLincs HMO Members have a unique network ID: HMO.
• The 3-character prefix is: YUH.

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How can I verify eligibility and benefits for MyBlue HMO Members?

Providers should verify eligibility and benefits prior to every scheduled appointment through Availity^® Essentials or your preferred web vendor. Eligibility and benefit quotes include participant confirmation, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. When services may not be covered, participants should be notified they may be billed directly.

How can a MyBlue HMO PCP obtain a required referral?

• MyBlue HMO PCPs are required to submit referrals for their MyBlue HMO Members for services the MyBlue HMO PCP is not able to provide. This includes services provided by MyBlue HMO specialists, hospitals, ancillary providers, and other providers. The referral request should be submitted to BCBSOK and the rendering provider or hospital.
• The MyBlue HMO PCP can submit the referral request online using the Availity Authorization & Referrals tool. Refer to the Availity Referrals User Guide to learn about the submission process. Referral requests may also be submitted via fax to 800-220-4045.

If the MyBlue HMO Member’s assigned PCP is not available, is a referral required for the MyBlue HMO Member to see another MyBlue HMO PCP?

If the MyBlue HMO PCP is located at the same physical address as the Member’s assigned PCP or has the same tax ID, then no referral is required.

Do emergency services require a referral?

Yes, the MyBlue HMO PCP is required to obtain a referral within two (2) business days of the emergency department visit or inpatient hospital admission.

What happens if the required referral is not obtained?

Failure to obtain the required referral may result in services being denied.

If you have questions, please contact your Provider Network Representative.