Blue Review - August 2017 

 

Blue Review

A Provider Publication

August 2017

News & Updates

Code-Auditing Enhancement

Effective Nov. 12, 2017, Blue Cross Blue Shield of Oklahoma (BCBSOK) will be implementing a code-auditing enhancement.*

 
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EFT and ERA Update for Non-Contracted Government Programs Providers

Effective July 24, 2017, if you are an independently contracted commercial Blue Cross and Blue Shield of Oklahoma (BCBSOK) provider who is enrolled to receive Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) files from BCBSOK, you will also receive EFTs and ERAs for government programs member claims, even if you are a non-contracted BCBSOK government programs provider.

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Visit Our Website for Electronic Funds Transfer & Electronic Remittance Advice Resources

Blue Cross and Blue Shield Oklahoma (BCBSOK) recently updated the Electronic Funds Transfer (EFT) / Electronic Remittance Advice (ERA) page in the Claims and Eligibility section of our website at bcbsok.com/provider.

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Integration of Prime Therapeutics® and Walgreens® Specialty Pharmacy and Mail Order Services

BCBSOK’s pharmacy benefit manager (PBM), Prime Therapeutics LLC (Prime), and Walgreens announced a strategic alliance in August 2016 to create a first-of-a-kind model for pharmacy benefit management that aligns a national pharmacy chain, a leading PBM and health plans, including a long-term retail pharmacy agreement.

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Health Insurance for American Indians and Alaska Natives

American Indians and Alaska Natives (Al/ANs) can get care from Tribal and Urban Indian clinics and Indian health Services (IHS) facilities. However, Indian health care is not health insurance. The Health Insurance Marketplace gives Al/ANs special help to sign up and pay for insurance.

 
 
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Verifying Eligibility and Benefits for BCBSOK American Indian Members

Verifying eligibility and benefits electronically is the fastest way to access information for Blue Cross and Blue Shield of Oklahoma (BCBSOK) members.

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Support is Available for Members with Chronic Conditions

Blue Cross and Blue Shield of Oklahoma (BCBSOK) is committed to helping members with chronic conditions maintain a higher quality of life.

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We’re Here for You

Please call the toll-free number on the back of the member’s ID card if you have any questions or concerns about your patient’s benefits.

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Feature Tip

Colon Cancer Screenings Goal: 80% Participation by 2018 – Will You Commit?

In collaboration with the American Cancer Society and the National Colorectal Cancer Roundtable, Blue Cross and Blue Shield of Oklahoma (BCBSOK) and Dr. Joseph Cunningham, BCBSOK Chief Medical Officer, have signed a pledge to have 80 percent of our members ages 50-75, screened for colon cancer by 2018.

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In the Community

2017 Champions of Health Winners Announced

Resonance Center for Women, Inc. (Resonance) has been named the recipient of the Dr. Rodney L. Huey Memorial Champion of Oklahoma Health, the highest honor of the Champions of Health awards.

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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.

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 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.

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Web Changes

• Posted July Blue Review to Education and Reference Center/News and Updates/Blue Review page

• Posted Medicare Advantage Overpayment Recovery to the Education and Reference Center/News and Updates

• Updated Applied Behavior Analysis (ABA) Initial Treatment Request forms under the Education and Reference Center/Health Care Provider Forms

• Updated Clear Claim Connection webpage under the Education and Reference Center/Provider Tools

BCBSOK Online Provider Orientation

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

Medical Policy Reminder

Approved new or revised BCBSOK medical policies and their effective dates are posted on the BCBSOK website the first day of each month. These policies may impact your reimbursement and your patients’ benefits. You may 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 provider website.

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

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.

*The above notice does not apply to government programs claims.

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 any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.

bcbsok.com/provider

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an Independent Licensee of the Blue Cross and Blue Shield Association

1400 S. Boston, Tulsa, Oklahoma 74119

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