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| February 4, 2016 News and Updates Modifiers provide the way to report or indicate an alteration of a service or procedure without changing the definition of the current procedural terminology or CPT code. Reimbursement may change depending on the modifier being used. We have developed a Modifier Reimbursement Guide for your reference and have posted it to our website. Provider Update on BCBSOK Small Group Processing Extension Blue Cross and Blue Shield of Oklahoma (BCBSOK) has seen an unprecedented volume of new small group submissions for coverage effective January 1, 2016. The volume is more than four times our typical January submissions, and we are experiencing a delay in processing the necessary paperwork to implement these new groups into our system. Read More. Blue Cross and Blue Shield of Oklahoma (BCBSOK) behavioral health representatives are available to help with questions about member benefits, requests for authorization, care coordination, finding community resources for members and more. You can reach a BCBSOK behavioral health representative Monday through Friday from 8:00 a.m. to 6:00 p.m. Central Time. For assistance, just dial the Customer Service number on the back of the member’s ID card; call toll-free or collect. After normal business hours, you can leave a message in a confidential voicemail box. A representative will return your call within 24 hours and identify herself/himself by name, title and company name. BCBSOK behavioral health representatives are available 24 hours a day, seven days a week for crisis calls and emergency preauthorization requests via the Customer Service number on the back of the member’s ID card. BCBSOK Behavioral Health Quality Improvement Program Blue Cross and Blue Shield of Oklahoma (BCBSOK) is committed to improving our members’ experience and the value they receive from behavioral health care delivery. To meet these goals, BCBCOK identifies, monitors and evaluates clinical and service improvement opportunities through the Behavioral Health Quality Improvement (BHQI) program. BHQI reviews behavioral health care management and quality improvement programs annually to assess progress toward identified goals as well as the overall effectiveness of the behavioral health program. BHQI has helped improve quality of care for our members by implementing programs that:
To ensure we are providing optimal service to our members, BHQI tracks whether members and providers have suitable phone access to BCBSOK and whether members have appropriate behavioral health provider network options in their geographic areas. BHQI also responds to complaints and quality of care concerns regarding the behavioral health program or behavioral health providers. The BCBSOK behavioral health program is accredited by nationally recognized health care quality organizations, including the Utilization Review Accreditation Commission (URAC) and the National Committee for Quality Assurance (NCQA). For more information about the BHQI program, you can send an email to bhqualityimprovement@bcbstx.com How providers can impact HEDIS 2016 Plan and Network Changes for Oklahoma Individual PPO Market – More Training Opportunities ICD-10 ‘Coding Basics’ Video and Other Resources While it may take time for providers, payers, clearinghouses and other vendors to adjust completely, it appears that the national transition to ICD-10 has been largely successful. The Centers for Medicare & Medicaid Services (CMS) continues to release educational resources for providers, such as a recent video titled, “ICD-10 Post-Implementation: Coding Basics Revisited.” This video covers such points as the CMS definition of a valid code, basic guidelines for coding and reporting on claims, as well specific examples (7th character, unspecified codes, external cause codes, laterality, etc.) and information on resources for coders. The 33-minute video features American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman, MJ, RHIA, CCS, FAHIMA, and Nelly Leon-Chisen, RHIA, from the American Hospital Association (AHA). The Coding Basics Revisited video may be accessed via the CMS website at cms.gov/icd10. For your convenience, a link to the video also is posted in the Standards and Requirements/ICD-10 section of our website at bcbsok.com/provider. You’ll also find links to other ICD-10 resources on our Provider website, such as updated answers to frequently asked questions. Update to BCBSOK Preferred Pharmacy Network for 2016 Individual or Employer-offered “Metallic” Plans As previously communicated, BCBSOK “metallic” or QHP health plans, offered for retail individual or employer-offered small group (1-50), have a Preferred Pharmacy Network added to the 2016 pharmacy benefit. There is an update to this network. Pharmacy Providers of Oklahoma, Inc. (PPOk), a group of independent pharmacies, has been added. PPOk is in addition to the preferred pharmacies CVS, Walmart (also known as Sam’s Club Pharmacy) and Access Health (a group of independent pharmacies). The OK Preferred Pharmacy Network listing has been updated on the MyPrime.com and News Alert section in the BCBSOK website. Feature Tip
If you would like to schedule a training session at your practice, contact Shannon Capetillo,Shannon_capetillo@hcsc.net. For hospital training sessions, please contact Melissa McEachern-Wilkins, Melissa_mceachern-wilkins@bcbsok.com. In the Community Blue Cross and Blue Shield of Oklahoma is Proud to Celebrate Dr. Martin Luther King, Jr. On Jan. 18, 2016 thousands of spectators braved the cold for the annual Dr. Martin Luther King, Jr. Day parade in Tulsa, Oklahoma. The parade is one of the largest in the United States and the African Americans In Motion (AAIM) Business Resource Group, Tulsa Chapter, coordinated BCBSOK’s involvement. More than thirty employees marched in the parade while carrying a BCBSOK banner, handing out promo items and holding signs. BCBSOK President Ted Haynes, along with AAIM Executive Sponsor Nicole Amend and other executive leadership team members marched alongside the employees. The 2016 parade theme was “One Race: The Human Race.” BCBSOK has participated in the parade and had a strong presence for the past several years.
Photo Caption: More than thirty employees marched in the parade while carrying a BCBSOK banner, “One Race: The Human Race.” Web Changes
Provider Data and Directory Updates Maintaining accurate provider data and directories are an important part of providing Blue Cross and Blue Shield of Oklahoma (BCBSOK) members with the information they need to manage their health. Please review our online provider directory, Provider Finder, at Provider Finder®. The directory is a helpful tool for providers to refer their BCBSOK patients to other participating providers. To update your directory information or other provider information such as tax identification numbers, supervising physician information, hospital privileges, etc., please submit the BCBSOK Provider Notification/Contract Request Form via fax to 918-549-2141 or email the form to oknetworkmanagement@bcbsok.com. All changes should be submitted at least 30 days in advance of the effective date of change. For more information, please contact your BCBSOK Provider Network Representative. BCBSOK Online Provider Orientation Medical Policy Reminder While some information on new or revised medical policies may occasionally be published for your convenience, please visit bcbsok.com/provider for access to the most complete and up-to-date information. On-demand Training | |||||||
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