September 2017

Your Feedback is Important

Blue Review strives to offer important information each month to our contracted providers. To deliver the content that’s most relevant to you and your staff, Blue Cross and Blue Shield of Oklahoma (BCBSOK) needs your feedback. Please take a few minutes to complete our brief survey. As a thank you for your time, we’re providing an opportunity to win one of five, $25 Amazon.com® gift certificates. (Note: Government employees are not eligible.)

Government Programs: Claims Rejecting as Duplicate Submissions

This notice applies to claims submitted by government programs providers for the following Blue Cross and Blue Shield of Oklahoma (BCBSOK) members: 

• Blue Cross Medicare Advantage (PPO)^SM (MA PPO)

• Blue Cross Medicare Advantage (HMO)^SM (MA HMO)

Blue Cross Medicare Advantage^SM: Electronic Claim Submission Edits

On Sept. 16, 2017, Blue Cross and Blue Shield of Oklahoma (BCBSOK) implemented new electronic claim submission validation edits for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Professional and Institutional claims (837P and 837I transactions).

Requesting predetermination of medical necessity

As a reminder, predetermination of medical necessity requests may be submitted electronically through iExchange^®, which is accessible through the Availity^TM Web portal.

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program

This article pertains to all Medicare physicians, providers and suppliers, including those serving beneficiaries enrolled in Original Medicare or a Medicare Advantage (MA) plan.

The QMB program is a State Medicaid benefit that covers Medicare premiums and deductibles, coinsurance, and copayments, subject to State payment limits. (States may limit their liability to providers for Medicare deductibles, coinsurance, and copayments under certain circumstances.)

Do your Patients know the difference between Urgent Care Centers and ERs

Do your patients know when they should go to an urgent care center instead of an ER? It can be confusing, but knowing the difference may save them money.

Let’s say this right up front — if your patients have a life-threatening emergency, their safest option is to go to the nearest hospital emergency room.

Colorectal Cancer Screening Options and Statistics – Get the Conversation Started Today

Will You Commit?

In 2017, the American Cancer Society estimated there would be 135,430 new cases of colorectal cancer and 50,260 deaths nationwide. For Oklahoma alone, it was estimated that there would be 1,610 new cases of colorectal cancer with an estimated 710 deaths.

Champions of Health Gala set for September 28

The 14th annual Champions of Health gala will be held on Thursday, Sept. 28 at 6 p.m. at the Cox Business Center in Tulsa.

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.

• Posted August Blue Review to Education and Reference Center/News and Updates/Blue Review page
• Posted Code-Auditing Enhancement to the Education and Reference Center/News and Updates
• Posted Government Programs: Claims Rejection as Duplicate Submissions to the Education and Reference Center/News and Updates
• Updated Verifying Eligibility and Benefits for BCBSOK American Indian Members to the Education and Reference Center/News and Updates

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

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. 

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.

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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