The Quality Improvement program implements mechanisms to identify, monitor, evaluate, and resolve issues that impact the accessibility, availability, continuity, and quality of care and service provided to our members.
In an effort to standardize the Utilization and Case Management processes for Blue Cross and Blue Shield of Oklahoma, changes have recently taken effect. Learn about these new changes and updates.
Preadmission Certification (precertification) and Admission Certification are processes used in order to determine that services are medically necessary. Find out about requirements, how to request precertification and other vital information.
Blue Cross and Blue Shield of Oklahoma has the contractual "Right to Offset." This right allows us to retract overpayment amounts from future payments. Learn about notification, processes and other important information.
Information about the changes to the Blue Cross and Blue Shield of Oklahoma Behavioral Health Program effective January 1, 2011. Learn more about the Behavioral Health Care Management Program.
BCBSOK is licensed as a sponsor of the Bridges to Excellence® (BTE) Diabetic Care Recognition program and Cardiac Care Recognition programs. Learn more about Bridges to Excellence.
Clinical Practice Guidelines (CPGs) are adopted by BCBSOK, and are incorporated into Condition Management Programs. Learn more about Clinical Practice Guidelines.