At Blue Cross and Blue Shield of Oklahoma, we are committed to providing support to physician practices. We've designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.
Availity® Attachments: Submit Recommended Clinical Review Requests
Attachments is an online tool in the Availity Essentials portal that allows you to submit electronic recommended clinical review (formerly predetermination of benefits) requests handled by BCBSOK. Learn More
Availity® Authorizations & Referrals
Authorizations & Referrals is an online tool in the Availity Provider Portal that allows you to submit prior authorization and/or referral requests handled by BCBSOK. Learn More
Availity® Eligibility and Benefits
It is important to verify membership and check coverage details for every patient at every visit before you administer treatment.
To obtain fast, efficient, detailed benefits information for BCBSOK members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.
For additional details refer to the Availity Eligibility and Benefits User Guide.
You must be registered with Availity to gain access to this and other online resources offered by Availity.
BlueApprovRSM
BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit inpatient and/or outpatient prior authorization requests for medical surgical, specialty pharmacy drugs and behavioral health services, as well as recommended clinical review requests for medical/surgical and specialty pharmacy drugs for many BCBSOK commercial members. Learn More.
Blue Distinction®
BCBSOK, in partnership with the Blue Cross and Blue Shield Association, has developed Blue Distinction Centers. Each Center has been selected through a rigorous, evidence-based, objective selection criteria established with input from medical experts and organizations.
Blue Distinction is a nationwide program that will create an unprecedented level of healthcare transparency with two goals: engaging consumers to enable more informed healthcare decisions and collaborating with providers to improve quality outcomes and affordability.
To learn more about the program, selection criteria, and designated centers in each state, visit Blue Distinction for ProviderSM.
Claim Inquiry Resolution - High-Dollar, Pre-Pay Reviews
Claim Inquiry Resolution is available via a tab in our Electronic Refund Management system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims (Medical Records and/or Itemized Bills) handled by BCBSOK. Learn more.
Claim Reconsideration Requests
The electronic Claim Reconsideration option allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity’s Dispute Claim capability anchored off the enhanced Claim Status tool. Learn more.
Claim Status Tool
The Availity® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSOK. Learn more
Clear Claim Connection
Clear Claim Connection is a Web-based code auditing reference tool that mirrors BCBSOK edits (i.e., unbundling, mutually exclusive, and incidental). Learn more.
CoverMyMeds®
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization requests for prescription drugs that are part of BCBSOK pharmacy PA program. Learn more.
Electronic Claim Submission via Availity® Provider Portal
Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to BCBSOK, at no cost. Learn More.
Electronic Clinical Claim Appeal Requests via Availity®
The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Learn More.
Electronic Refund Management
This online refund management tool will help simplify overpayment reconciliation, as well as related processes and transactions. Use the ERM tool now.
Fee Schedules via Availity® (Professional Providers)
The Availity Fee Schedule viewer tool allows professional providers participating with BCBSOK to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Learn more.
Manage My Organization in Availity® Essentials
Manage My Organization in Availity Essentials allows administrators and administrator assistants to add, edit and/or delete provider(s) information within your organization(s) for easy data entry when submitting transactions via Availity handled by BCBSOK. Learn more.
Medical Record Status Viewer
The Medical Record Status Viewer is an online application that allows providers to confirm receipt of up to four of the most recent medical records submitted by mail or fax to BCBSOK for claim processing and prior authorization requests. Learn more.
Message This Payer Application
The Message This Payer application in Availity® Essentials allows providers to send secure messages to BCBSOK for claim management questions and follow along with the conversation history. Learn more.
National Drug Code Units Calculator Tool via Availity®
The National Drug Code Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System or Current Procedural Terminology codes to NDC units. Learn More.
Patient Care Summary
Patient Care Summary is accessible via Availity® Essentials and provides an electronic health record sourced from claim-based information collected by BCBSOK from physicians, pharmacies, labs and other health care providers based on the last 24 months of claims data. Learn more.
Patient Cost Estimator
The Availity® Patient Cost Estimator tool provides real-time estimation of member responsibility. This feature can be utilized at the time of service, enabling professional providers to collect copayments, coinsurance and deductible amounts up front for BCBSOK members. Learn more.
Patient ID Finder
The Availity® Patient ID Finder tool allows providers to obtain the BCBSOK member ID number and group number by entering patient-specific data elements. Learn More.
Physician Efficiency, Appropriateness & QualitySM Program
Our PEAQSM program evaluates physician performance in a transparent and multidimensional way. Its goal is to work with the physician community to provide feedback on physician efficiency, appropriateness and quality of care. Learn More.
Provider Claim Summary
The Availity® Provider Claim Summary application allows users to readily view, download, save and/or print the Provider Claim Summary and other reports online, at no additional cost. Learn More.
Provider Data Management
Provider Data Management is a web-based tool in Availity® Essentials that allows professional, facility and ancillary providers to quickly update, validate and attest to the accuracy of their information on file with BCBSOK. Learn more.
Remittance Viewer
The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSOK in the 835 Electronic Remittance Advice. Learn More.
Social Determinants of Health Screening Tool
Social determinants of health are conditions in the environments where people live, learn and work that affect a wide range of health and quality-of-life outcomes and risks.
BCBSOK wants to help you identify patients that may need assistance with social factors that impact their health.
Please use this Social Determinants of Health Screening Tool to determine if your patient may need additional assistance.
For more information and additional resources visit 211.org.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.