September 2023

Introducing Claim Reconsideration Requests via Availity^® Essentials

This option is for reevaluation of a claim that has been finalized.

Reporting On-Demand via Availity Essentials is Now Named Provider Claim Summary

Free webinars are available to help you learn more about this tool.

Shared decision-making aids can help guide care choices

This communication helps patients make decisions about their health care and can improve their experience.

Keeping an Eye on Improved Provider Collaboration

These American Diabetes Association^® screening patient recommendations are key guidelines for eye care specialists and primary care providers.

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

Don’t miss these requests for Blue Cross Group Medicare Advantage (PPO)^SM members.

Continuity of Care is Driven by Prompt Communication Upon Hospital Discharge

Electronic Health Records improves the flow of information when discharging a Federal Employee Program^® member to their next level of care.

Importance of Early and Timely Intervention for Pre- and Post-Partum Care to Help Improve Health Outcomes

Here are important care tips for Federal Employee Program members during their pregnancy journey.

See New Enhancements for Behavioral Health Pre-service Reviews

The BlueApprovR^SM tool will help improve the efficiency in getting pre-service requests for reviewed and approved.

Pharmacy Program Quarterly Update Changes Effective October 1, 2023 – Part 1

Check out these drug list changes that will be effective Oct. 1, 2023.

Submitting Claims for Infertility Services

Make sure the recipient is noted when completing these forms.

BlueApprovR aims to improve patient care and provider response times

The BlueApprovR tool is intended to streamline and accelerate the prior authorization process.

What Do Blue Cross and Blue Shield of Oklahoma (BCBSOK) Members Want from their Health Care Professionals? Part 1

In support of our Member CAHPS Survey Responses, BCBSOK shares this valuable feedback with our providers. This is the beginning of a three-part series to help us find possible gaps in care.

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: August Blue Review to Education and Reference Center/News and Updates/Blue Review webpage.
• Posted: In-Home Test Kits for Colorectal Cancer Screening to Education and Reference Center/News and Updates webpage.
• Posted: Webinar on Coding for Morbid and Severe Obesity to Education and Reference Center/News and Updates webpage.
• Posted: Pharmacy Program Updates: Quarterly Pharmacy Changes Effective July 1, 2023 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 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.

Do you have a helpful suggestion or feedback about our website? Fill out our Feedback Survey.