January 14, 2016 News & Updates
Patient “After Hours” Care
The Blue Cross and Blue Shield of Oklahoma (BCBSOK) access standard policies have been updated to include criteria for “After Hours” care. Read more. Implementation Reminder: Three New Facility Rules for ClaimsXten™, Effective Feb. 22, 2016
New details regarding three new facility rules that were originally scheduled to be added to our claims processing system effective Oct. 12, 2015, as an enhancement to our ClaimsXten code auditing tool. Read more. Provider Updates and 2016 Plan and Network Changes for Oklahoma Individual PPO Market
The health insurance market has evolved significantly since the opening of the Health Insurance Marketplace in 2014. These changes require BCBSOK to make adjustments in 2016 that will allow us to continue offering sustainable health insurance options to Oklahomans across the state. A special News Alert explaining all of the changes for the Oklahoma retail market in 2016 was emailed to providers on Tuesday, Dec. 15, 2015. 2015 to 2016 Medicare Part D Formulary Changes
Based on CMS mandates and a regular review of changes in the pharmaceutical marketplace, the Blue Cross MedicareRx/Blue Cross Medicare AdvantageSM 2016 Part D plans will have formulary and utilization management changes for 2016. Read more. Medicare Part D Prescriber Enrollment
Effective June 1, 2016, CMS is requiring that all providers who prescribe drugs for Medicare Part D patients must enroll in Medicare or validly opt out, if appropriate. Read more. Healthy Activities Rewards and Incentives for Blue Cross Medicare Advantage Members
Effective Jan. 1, 2016, Blue Cross Medicare Advantage members can earn rewards for completing selected screenings, managing chronic conditions, or seeing a physician for a physical. A complete listing of healthy activities and incentives is located in the Network Participation/Medicare/Rewards and Incentives section of our provider website. For additional information about the Blue Cross Medicare Advantage program, please visit the Network Participation/Medicare section on the bcbsok.com/provider website. New Guide Outlines Member ID Card Basics
As an independently contracted BCBSOK provider, you may render services to BCBSOK members, as well as other Blue Plan members who travel or live in Oklahoma. Read more. Pharmacy Program Benefit Changes – Effective Jan. 1, 2016
BCBSOK will be implementing pharmacy benefit changes as of Jan. 1, 2016, for some members with prescription drug benefits administered through Prime Therapeutics. Read more. Featured Tip
Pharmacy Program Updates: Quarterly Pharmacy Changes Effective Jan. 1, 2016
Review revisions made to the BCBSOK standard drug list and generics plus drug list that are effective Jan. 1, 2016. Read more. In the Community
Blue Cross Sponsors 2015 Route 66 Marathon
BCBSOK is proud to have been the presenting sponsor of the 10th annual Williams Route 66 Marathon, held Friday, Nov. 20 through Sunday, Nov. 22, 2015 in Tulsa. Read more. 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®. 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 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. 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. | 