Recent Utilization and Case Management Changes

In an effort to standardize the Utilization and Case Management processes for Blue Cross and Blue Shield of Oklahoma, the following changes will take effect July 5, 2011:

  • All calls related to Case Management (CM) will originate in the Provider Customer Service Unit (PIU) at 1-800-496-5774. The caller will be transferred to a Health Coordinator (HC) in the CM department. The HC will call the member to arrange an appointment to speak with the case manager.
  • Wheelchair authorizations will now be handled through the pre-authorization process. CM can no longer accept these requests via fax. To request a wheelchair authorization please call the PIU at 1-800-496-5774.
  • Referrals for Hospice, Home Health, Long Term Acute Care, Skilled Nursing Facility, Rehabilitation, and Home Infusion will now be handled through the Utilization Management (UM) Department.
  • Precertification/Authorization may be requested via fax at 1-800-220-4045, or by calling our UM department directly at 1-800-672-2378. A UM clerk will start the process and provide a reference number. If clinical information is required, the caller will be transferred to a confidential voicemail or a UM nurse may call and request the information needed in order to determine medical necessity. If the necessary information is not available during the call, the submitter will be given two business days to respond. If it is determined the request does not meet medical necessity criteria, the submitter will receive a call to advise of the denial.
    • Helpful Fax and Voicemail numbers to expedite your request:

      Bluelincs 918-549-3048 918-551-2411
      Episodic 918-549-3049 918-551-2412
      Cardiac 918-549-3047 918-551-2413
      Behavioral Health 877-361-7660 877-906-6389
      Med Surg 918-549-3044 918-551-2415
      FEP 877-404-6455 800-441-9188
  • The UM clerks can now authorize Home Health services to include nursing visits, home physical therapy, occupational therapy, speech therapy, and home hospice care. Regardless of the quantity authorized, member benefit limits will apply.

Notification of approvals and administrative denials (lack of information) will be written only. Denials for medical necessity will be written and phoned to the requesting provider. For questions regarding these changes, please contact the PIU at 1-800-496-5774.