March 2018

Oklahoma Behavioral Health Provider Education Webinar; RSVP by March 28

On April 4, 2018, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will host an education session to help providers learn about medical necessity criteria.

Interpreting the ‘PLB’ Segment on the 835 ERA

There are reversals and corrections when claim adjudication results have been modified from a previous claim report. The method for revision is to reverse the entire claim and resend the modified data.

Availity^TM Claim Research Tool Offers Enhanced Claim Status Results

One of the most convenient, efficient and secure methods of requesting detailed claim status from Blue Cross and Blue Shield of Oklahoma (BCBSOK) is by using an online option such as the Availity Claim Research Tool (CRT).*

How Providers Can Impact HEDIS^®

The information in this article will help you better understand what is expected of you as a provider and how your compliance positively impacts HEDIS scores.

How to Keep the Cash Flowing

BCBSOK will be publishing a series of articles on ways for you to get paid quickly and efficiently. Topics will focus on how you can prevent delayed payments such as: keeping your information updated, reducing inaccurate claim submissions, and submitting claims and repeals on time.

The second article in this series focuses on preventing claim delays.

Helpful Tips for Preventing Claim Delays

On a recent review of claim denials, Blue Cross and Blue Shield of Oklahoma (BCBSOK) identified the most common issues that cause delays in claim processing.

Behavioral Health: Let’s Talk About It!

This month, we’re spotlighting an article from our online magazine, Making the Health Care System Work^SM. The Intersection of Physical and Behavioral Health Care explores some of the ways behavioral health and physical health symptoms can fuel each other, and how data analytics are helping Blue Cross and Blue Shield of Oklahoma (BCBSOK) further integrate behavioral health.

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^®. 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 the change. For more information, please contact your BCBSOK Provider Network Representative.

• Posted February Blue Review to Education and Reference Center/News and Updates/Blue Review page
• Posted Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2018, to Education and Reference Center/News and Updates
• Posted Training Webinar Schedules for Second Quarter Education and Reference Center/Training

We have an insider’s view of how health insurers, doctors, hospitals, employers and governments depend on one another to provide access to affordable, high-quality care and help people live healthy, productive lives. We put together a team of writers and multimedia creators to work with business and thought leaders, inside and outside of our organization, to explore ways we can all work together to make the health care system work better for everyone. Learn more about the online magazine we created to tell these stories.

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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