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BLUE REVIEWSM

for Providers

April 2024

Prior Authorization code updates for Medicare Advantage

What’s Changing: Blue Cross and Blue Shield of Oklahoma is changing prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association. A summary of changes is included below.

Important Reminder: Always check eligibility and benefits first through the Availity® Essentials Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Changes Include:

More Information: For a complete and up-to-date list of codes, go to our provider website in the Utilization Management section.

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Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.