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for Providers

March 2024

Closing Gaps in Colon Care

Adults age 45 to 75 should have preventive screenings to reduce their risk of colorectal cancer, according to the U.S. Preventive Services Task Force and Centers for Disease Control and Prevention. Colorectal cancer is becoming more common in people younger than 55. We encourage you to discuss colon health and screening options with our members. We’ve created resources for members to help.

Recommended Screening
USPSTF recommends screening with any of the following tests for adults age 45 to 75:

Closing Care Gaps
Colorectal Cancer Screening is a Healthcare Effectiveness Data and Information Set (HEDIS®) measure that tracks appopriate screenings for adults age 45 to 75. To help close gaps in our members’ care, consider these tips:

Checking Eligibility and Benefits
Check member eligibility and benefits using Availity® Essentials or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles.

For most of our members, preventive colorectal cancer screening is covered at no cost share. For diagnostic tests for colorectal cancer, our members may have out-of-pocket costs. This includes diagnostic tests for members who have signs of health problems or a family history of disease. Learn more.

Some screenings involve a member’s pharmacy benefits in addition to their medical benefits, such as the prep kit for colonoscopies. For details about pharmacy benefit coverage, call the number on the member’s ID card. A member’s pharmacy benefit may be managed by a company other than Blue Cross and Blue Shield of Oklahoma.

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The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Cologuard is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide laboratory services for members with coverage through BCBSOK. 

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. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

HEDIS is a registered trademark of the National Committee for Quality Assurance.