Education and Reference Center

It’s important to provide our valuable network of health care providers with the information and tools they need to help them help their patients, as well as provide any needed training support. Stay informed with the latest updates and tools for health care providers.


News and Updates

Stay informed about news and developments that may affect your practice, patient treatment and the submission of claims. View News and Updates now.


Provider Tools

We created useful and powerful tools to help you conduct research on specific conditions, evaluate costs and even simplify billing. Explore these Provider Tools now.


Forms

Access all the approved health care forms you need for authorizations, appeals, claims processing and more, all in one place. View and download Health Care Provider forms now.


Training

Learn about the Availity EDI software, or about a wide range of topics critical to health care practices. We offer free educational webinars. View available webinar training sessions now.


Provider Orientation

As a newly contracted BCBSOK physician or other professional provider (or a new employee of a contracted provider's office) we encourage you to take advantage of the reference materials available to you online. View provider introductory information now.


Provider Claims Summary/Explanation of Claims Summary

Explanation of Claims Summary is an explanation of claims submission. You can use the Explanation of Claims Summary to determine how a claim was processed, including non-allowed amounts or adjustments. The Explanation of Claims Summary will note any appropriate deductible and coinsurance amounts that are the responsibility of the member, in addition to any non-allowed amounts that are the responsibility of the member or the provider.

The first page of the Explanation of Claims Summary lists and explains all codes used in processing each claim in the report. If claim reports are separated for billing or accounting purposes, it is important to make sure every associate receives a copy of the first page(s) which lists and describes all codes contained in the report.

If, for any reason, an amount is non-allowed when processing your claim, the non-allowed code and description will appear on your Explanation of Claims Summary. The Explanation of Claims Summary accompanies every check issued by Blue Cross and Blue Shield of Oklahoma. The first page of the Explanation of Claims Summary will list and describe all non-allowed codes applied to the processed claims contained in the Explanation of Claims Summary report. For each claim, any applicable message and/or reason codes will be listed in the Explanation of Claims Summary.

View a sample of the Provider Claim Summary for services billed on a UB-04 form .

View a sample of Provider Claim Summary for services billed on a CMS-1500 form .


Resources

Resource Guides

Contacts

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