Blue Review – Oklahoma Division

BlueCross BlueShield of Oklahoma
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Blue Review

For Providers

January 2024


News & Updates

Reminder: Update Your Records with New Mailing Address for Paper Commercial Claims and Inquiries 

Do not miss this important address change for your mailing records.

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Update Your Records: New Medicare Open Access PPO Members and ID Cards

All Medicare Advantage members receive new ID cards Jan. 1. Newly enrolled members also have new ID numbers.

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Prior Authorization Codes Updated for Commercial Members

Always check eligibility and benefits first through Availity® Essentials or your preferred vendor portal, prior to rendering services.

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Prior Authorization code updates for Medicare Advantage

There will be updates to the addition of medical drugs codes beginning April 1, 2024.

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Blue Cross and Blue Shield of Oklahoma began issuing direct payment to out-of-network providers, effective Nov. 1, 2023

This decision makes for a more efficient reimbursement process for out-of-network providers.

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Three New ClaimsXten™ Rules to be Implemented March 2024

These software database changes to help alight coding with the reimbursement of claim submissions.

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Oral Oncology Pharmacy Network Transitioned to IntegratedRx™

This allows members to receive their oral oncology and other select medications at their health care provider’s clinic or hospital pharmacy.

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Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2024 – Part 1

Please don't miss these important pharmacy program quarterly updates.

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Monitoring Children Using ADHD Medication

NCQA recommends following up with children who are newly prescribed ADHD medication and who remain on medication long term.

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Remind Our Members about Cervical and Breast Cancer Screenings

Don't forget to remind our member about these important screenings as the calendar turns to 2024.

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BCBSOK’s Approach to Managing GLP-1 Agonist Medications

Beginning Jan. 1, 2024, members using a GLP-1 diabetes drug who do not have a diabetes diagnosis and other diabetes medication history on file will be required to go through the PA process.

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Centers for Medicare and Medicaid Services Guidelines for Availability and Access Standards to Care for Medicare Advantage Members

CMS applies these standards to primary care and behavioral health services and substance use disorder services.

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Hospitals Must Provide Medicare Outpatient Observation Notice

The notice explains why the members aren’t inpatients and what their coverage and cost-sharing obligations will be.

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Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

QMB beneficiaries are not responsible for Medicare Advantage cost-sharing, or out-of-pocket costs.

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Appropriate Use of Opioids Program to be Retired January 2024

This change will allow for flexibility and individualized care when it comes to prescription opioids.

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Utilization Management: How to Avoid Delays and Denied Claims

Here are tips on how to improve care with our members.

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Annual Medical Record Data Collection for HEDIS Quality Reporting begins Feb. 1

The records you provide as part of this process will help us validate the quality of care provided to our members.

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Provider Data and Directory Updates

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, specialty, address, phone and digital contact information.

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 . Facility and Ancillary providers may only use the Demographic Change Form to verify and update information. If we haven’t received your verification, look for emails from us with the checkmark symbol. They’re a friendly reminder that it’s time to verify. Learn more about verifying your data.

Web Changes

ClaimsXten™ Quarterly Updates

New and revised Current Procedural Terminology and Healthcare Common Procedure Coding System 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 to be evaluated during the claim adjudication process, you can continue to use Clear Claim Connection™ (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 to 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.

BCBSOK Online Provider Orientation

The Online Provider Orientation is a convenient and helpful way to learn about the online resources available to you.

Clinical Payment and Coding Policies Reminder

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.

On-demand Training

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.

Medical Policy Reminder

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 can 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 website.

While some information on new or revised medical policies occasionally be published for your convenience, please visit for access to the most complete and up-to-date information. 

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Stay Informed!

Watch News and Updates for important announcements.

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Provider Training

For dates, times and online registration, visit the Provider Training page.