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November 3, 2016 News & Updates Premium Paid-To-Date Now Included in BCBSOK Eligibility Response for On- and Off-Exchange Policies The premium paid-to-date for Blue Cross and Blue Shield of Oklahoma (BCBSOK) members who purchased their coverage on or off of the Health Insurance Marketplace is now available when verifying eligibility and benefits through your preferred online web vendor or clearinghouse. Read More Online Portal Applications Help Expedite Administrative Workflow Effective Jan. 1, 2017, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will implement a change for rehabilitative and habilitative services that are essential health benefits (EHB) and billed by Physical Therapy, Speech Therapy, and Occupational Therapy providers as well as any other providers that may bill for these services. This new change will apply to Blue Advantage PPOSM and Blue Preferred PPOSM members enrolled in qualified health plans under the Affordable Care Act. This does not apply to other BCBSOK plans. Read More Effective Jan. 1, 2017, BCBSOK directs providers to use CPT® Code 90674 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage) when billing for Flucelvax Quadrivalent. Until the CPT code 90674 becomes effective, Flucelvax Quadrivalent should be billed with CPT code 90749 (Unlisted vaccine/toxoid). CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. Modifier 26 denotes professional services for lab and radiological services. Modifier TC denotes technical component for lab and radiological services. These modifiers should be used in conjunction with the appropriate lab and radiological procedures only. Note: When the same physician or professional provider and facility or ancillary provider performs both the technical and professional service for a lab or radiological procedure, he/she must submit the total service, not each service individually. New Preauthorization Requirement for Applied Behavioral Analysis Effective Jan. 1, 2017, there will be a requirement for a preauthorization for Applied Behavior Analysis (ABA) for the treatment of Autism Spectrum Disorder for eligible Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. Preauthorization for these services is processed through Behavioral Health Medical Management Review, by calling the number on the member’s ID card. Read More Effective Oct. 3, 2016, Blue Cross and Blue Shield of Oklahoma (BCBSOK) has contracted with eviCore healthcare (eviCore)*, an independent specialty medical benefits management company, to provide preauthorization services for new requirements outlined below. Read More New Payer ID for Blue Cross Medicare Advantage Effective Jan. 1, 2017, changes affecting claims submissions for Medicare Advantage Plans will assist in streamlining claims processing and improve efficiencies of claims routing to our primary claims adjudicator. Read MoreClaimsXtenTM Quarterly Updates Coordination of Care Between Medical and Behavioral Health Provider Prime Pharmacy Network Change Effective Jan. 1, 2017 Effective Jan. 1, 2017 (regardless of renewal policy date), CVS pharmacies and CVS pharmacies in Target stores will no longer be a part of BCBSOK’s standard pharmacy network with Prime. Read More 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 at Provider Finder. The directory is a helpful tool for providers to refer their BCBSOK patients to other participating providers. Read More Provider Notification Form Update Feature Tip Fall means football, and that brings the start of concussion season. And like the football flying off the hands of the quarterback, the number of people diagnosed with concussions is soaring. Overall, the number of people diagnosed with concussions grew 40 percent from 2010 to 2015. The most dramatic uptick in concussion diagnoses in that time period was for patients ages 10 through 19. For them, concussion diagnoses jumped 70 percent. Special Notification for Bluecard Members Blue Cross and Blue Shield of Nebraska notified BCBSOK of a change in their policy In the Community Champions of Health Event Inspires All to Work Toward a Healthier Oklahoma On Tuesday, Sept. 27 more than 500 people gathered at the 13th annual Champions of Health gala to honor those working toward a healthier Oklahoma. The event, which benefits the Oklahoma Caring Foundation, was held at the National Cowboy and Western Heritage Museum in Oklahoma City. KWTV News9’s weekday morning anchor Lacie Lowry emceed the event, which named six organizations from across the state as Champions of Health. After the awards were presented, attendees were treated to a moderated question-and-answer session with author and actor Rob Lowe, where he discussed his sobriety and advocacy for breast cancer awareness, as well as his ability to maintain work-life balance. Read More It’s Not Too Late to Receive a Member Discount on Route 66 Marathon Events! Web Changes
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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