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2010 Provider News and Updates

Changes in Contracting for Nurse Practitioners and Physician's Assistants

December 7, 2010


Effective January 1, 2011, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will begin contracting directly with Nurse Practitioners (NP) and Physician's Assistants (PA).


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New Code Auditing Tool to Help Improve Claim Processing

December 1, 2010


In the October Network News and News and Updates section of the Provider website, we announced the implementation of new code auditing software within the BCBSOK claim processing system. On or after April 18, 2011, BCBSOK will implement ClaimsXtenTM, a code auditing tool developed by McKesson Information Solutions, Inc.


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Childhood Asthma: Newest Be Smart. Be Well.® Topic

October 25, 2010


About 7 million children in the United States have asthma, and more than 4 million had an asthma attack last year. It causes more than 700,000 emergency room visits each year, according to the American Lung Association.


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Behavioral Health Program Changes: Updated FAQs Available

October 22, 2010


As announced, changes are being made to the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Behavioral Health Program effective January 1, 2011. We have updated the previously posted Frequently Asked Questions (FAQs) that review how the upcoming changes may affect you. You can access the updated FAQs  in the Clinical Resources section of our website.


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IVR Claim Status Menu Changes in October

October 18, 2010


We are continuing to enhance efficiency of the self-service claim status menu options offered by our Interactive Voice Response (IVR) phone system. Beginning Oct. 18, 2010, you will have the option to speak to a Customer Advocate (CA) only after you obtain responses via the IVR at both of the following claim status levels:

  1. Overall status – check amount, paid date, etc.
  2. Line item detail (professional claims only) – allowable amounts, ineligible reason codes, etc.

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New Preferred Provider for Immunoglobulin (IVIG) Therapy Services

October 15, 2010


Effective Sept. 1, 2010, Coram Specialty Infusion Services will be the preferred provider of intravenous immune globulin (IVIG) home infusion therapy services for members in the Blue Cross and Blue Shield of Oklahoma (BCBSOK) PPO network.


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Reserve your seat for the Champions of Health Awards

October 5, 2010


Last chance to reserve seats at the Champions of Health awards Oct. 18. The event will feature Emmitt Smith as keynote speaker. Make reservations through Oct. 6.


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Network News

September 13, 2010


View the current edition of our provider newsletter . Read about current programs, policies and updates to help you stay informed about Blue Cross and Blue Shield of Oklahoma.



NPI-related Errors to Result in Electronic Claim Rejection

September 3, 2010


An updated NPI-only Electronic Claim Submission Edits listing  has been posted in the Electronic Commerce Alerts section of our website. Please be advised that most of the edits/error listings that were formerly set at the Warning level will be set to Reject as of Sept. 6, 2010.


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Behavioral Health Program Changes FAQs

July 26, 2010


Changes are being made to the Blue Cross and Blue Shield of Oklahoma Behavioral Health Program effective January 1, 2011. For more information about how these changes will impact you, read the Integrated Behavioral Health Program Changes FAQ document .




New Online Resource Available for Maternity Program

July 23, 2010


Blue Cross and Blue Shield of Oklahoma (BCBSOK) is pleased to announce an additional resource is now available for the Special Beginnings®’ program. All expectant members who have this maternity program as part of their health plan have access to a new online resource beginning in late July 2010.


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IVR Claim Status Menu Changes in July

July 16, 2010


Beginning July 19, 2010, you will notice the following changes when you call our Provider Inquiry Unit (PIU) to obtain basic claim status information via our automated Interactive Voice Response (IVR) phone system.


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Care Comparison® Data Collection Form Instructions

July 02, 2010


This form is for Hospitals, Ambulatory Surgery (ASC) and Free-standing Radiology (FSR) Centers that received a letter from BCBSOK requesting updated information for our Care Comparison tool.

You will be using this online form to report the total volume for each procedure and service performed at your facility. The volume should include totals for all payers (i.e., Medicare, commercial, self-pay, etc.) for dates of service from January 1, 2009, through December 31, 2009.


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Availity Launches New Look and Easier to Use Web Portal

June 21, 2010


In order to provide better user service and aid navigation, Availity has upgraded its multi-payer web portal. The new portal home page features updated navigation menus and a fresher, streamlined appearance.

The changes are in response to user requests for easier navigation to the Availity services they use most frequently. The new look is only currently applied on the home page and a few of the sub pages of the portal. Additional changes will roll out across the entire site during the course of the next year.


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Nominate a Champion of Health Online Now through July 30

June 16, 2010


Do you know a health Champion? Nominations are open for the seventh annual Champions of Health awards, BCBSOK’s premier community event benefiting the Oklahoma Caring Foundation.


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BCBSOK Designates Oklahoma Heart Institute on the Campus of Hillcrest Medical Center and INTEGRIS Baptist Medical Center as Blue Distinction Centers for Cardiac Care®

June 10, 2010


Blue Cross and Blue Shield of Oklahoma recently designated Oklahoma Heart Institute on the Campus of Hillcrest Medical Center in Tulsa and INTEGRIS Baptist Medical Center in Oklahoma City as Blue Distinction Centers for Cardiac Care. Through the Blue Distinction Center designation, Blue Cross and Blue Shield members have a credible means of identifying hospitals that meet their individual health care needs for select procedures and conditions.


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Online Inpatient Precert Requests Now Available for Providers

June 10, 2010


In our continuing efforts to offer online solutions to assist our providers, we have now implemented iEXCHANGE.  This is an internet pre-certification and concurrent review tool that allows facilities to request, view, extend and ultimately manage cases real-time.  This FREE functionality is available immediately to hospital providers and admitting physicians via the internet and does not require any additional software.


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Blue Cross and Blue Shield of Arkansas Administers Wal-Mart Health Plans

June 9, 2010


As of January 1, 2010, Blue Cross Blue Shield of Arkansas became the single Blue Plan administering health plan benefits for Wal-Mart associates. However, many 2010 claims are still being filed using old prefixes.


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NPI Edit Update Notification Effective June 7

May 31, 2010


The following BCBSOK NPI Submission Edit will be set to a Reject ("R") effective June 7, 2010.

The edit QGC, which currently reads "NPI IS NOT ON FILE," has been updated and is set to reject June 7, 2010 now reads as follows:

QGC — Billing NPI IS NOT ON FILE FOR PAYOR

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Lowe's — Prior Certification Required for Specialty Drugs

May 27, 2010


In March 2010, Lowe's Companies, Inc. began utilizing Care Continuum, an independent utilization management company, for prior certification of specialty drugs and specialty drug claim management.


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BCBSOK Offers a New Solution for Credentialing

May 25, 2010


Blue Cross Blue Shield of Oklahoma (BCBSOK) has chosen the CAQH® Universal Provider Datasource (UPD)® to electronically collect the data we require to credential physicians and other health care providers contracted for our BCBSOK networks and for BlueLincs HMO. The UPD utilizes an online credentialing application process that supports the health care industry administrative simplification and paper reduction efforts.


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A Review of Non-covered Allergy Testing and Treatment Methods

May 24, 2010


For BCBSOK providers who perform allergy testing and/or treatment, it is important to note that Serial Dilution Endpoint Titration/Serial Endpoint Titration (SDET/SET) and Sublingual Immunotherapy (SLIT) are services that are not covered by BCBSOK.


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Updates to Modifier 59

May 24, 2010


Effective June 14th, 2010, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will make updates to the Modifier 59 exempt code pair logic through our code auditing tool, ClaimCheck®. These changes are based on the updates to the CMS National Correct Coding Initiative (NCCI) code auditing system.


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Outpatient Claim Submission Reminders for Facility Providers

May 8, 2010


If you are an institutional provider who submits outpatient claims on paper and/or electronically, please be advised of the following information.

An outpatient HCPCS code is required at the service line level, if applicable, in the following locations:


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Predetermination: Important Tips

May 8, 2010


Predetermination of Benefits — A voluntary, written request for review of treatment or services; includes services that may be considered experimental, investigational or cosmetic. Predetermination approvals and denials are usually based on provisions in our medical policies. A predetermination of benefits is not a substitute for the precertification process.


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Physical, Occupational and Speech Therapy Services Billed with an Evaluation and Management Code

May 7, 2010


It is not within the scope of practice for Physical, Occupational and/or Speech Therapy providers to bill for Medical Examinations (Office Visit) CPT codes. Such CPT codes are designed for evaluation and management of an injury or illness. If an evaluation is being performed for Physical, Occupational or Speech Therapy, there are appropriate Therapy Evaluation CPT Codes available. These codes are designed for evaluation of therapy related injuries and/or illnesses. For a list of appropriate Therapy Evaluation Procedure Codes, please refer to the CPT Manual or contact the AMA at 800-621-8335.




Stay Informed with Electronic Commerce 'Alerts'

April 30, 2010


Does your office submit claims electronically or receive claim payments via Electronic Funds Transfer (EFT)? Are you enrolled for Electronic Remittance Advice (ERA)/Electronic Payment Summary (EPS)? If you conduct business electronically with BCBSOK, it is very important to become a regular visitor to our Electronic Commerce Alerts page.


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Free Electronic Health Record Via Availity® CareProfile®

April 23, 2010


CareProfile is a user-friendly, electronic health record that assists health care professionals in making informed treatment decisions for their patients. It's available free of charge to physicians and provider organizations registered with Availity in Oklahoma. To register, visit availity.com , or call Availity Client Services at (800) AVAILITY (282-4548).


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BCBSOK and MEDecision to Launch Medical Home Pilot

March 29, 2010


Blue Cross and Blue Shield of Oklahoma is teaming with MEDecision and a local physician group to provide a medical home pilot in Tulsa. The pilot will affect approximately 20,000 Blue Cross and Blue Shield of Oklahoma members receiving care from 45 physicians of a Tulsa clinic.


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Care Comparison Tool Offers Data Transparency

March 5, 2010


In September 2009, we unveiled a new online Care Comparison tool that allows our members to review costs for specific procedures performed at hospitals, ambulatory surgery centers and free-standing radiology centers in the BCBSOK provider network. Members also can review the volume of services performed by each facility, and they can obtain other information based on factors most important to them.


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Resolved: Missing Information on 835 Transaction



Blue Cross and Blue Shield of Oklahoma has identified an internal system issue affecting Electronic Remittance Advice (ERA) — ANSI 835 — transactions for electronic claims (ANSI 837 transactions) submitted January 1 through January 18, 2010. This issue has been resolved effective January 19, 2010.


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2010 Holiday Schedule



It is important to keep in mind that corporate and legal banking holidays may cause delays in Electronic Funds Transfers, Electronic Remittance Advice, Electronic Payment Summaries and Electronic Media Claims. View helpful information about these holidays, including Blue Cross and Blue Shield of Oklahoma's corporate holiday schedule


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Walmart 2010 Changes and Instructions



Effective January 1, 2010, there are changes that alter the way you file claims for Walmart associates. BlueAdvantage® Administrators of Arkansas will be the third-party administrator for all Walmart associates nationwide, including those previously administered by Blue Cross and Blue Shield of Oklahoma.


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Claim Tips for Healthcare Providers Now Available Online



For your convenience, a library of claim tips for health care providers has been created to allow providers continual access to ongoing information. Provider tools, tutorials, claim tips, newsletters, and interactive voice response (IVR) tips are all available on the Claim Tips for Healthcare Providers page.



Claim Number Sequence Changes on Medicare Crossover Claims



Blue Cross and Blue Shield of Oklahoma (BCBSOK) has completed an internal system upgrade for Institutional and Professional Medicare Crossover claims to allow for the implementation of the enhanced claim number sequence which is already in place for all other claims.


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Benefit and Eligibility Information Available by Fax



At Blue Cross and Blue Shield of Oklahoma, we are continually working to implement updates within our Interactive Voice Response Telephone System (eIVR) which will make your benefit and eligibility requests more user friendly. In an effort to enhance your experience, when you call to request benefits and eligibility, you can now request the information be provided to you by fax. The information you receive will mirror what you were quoted on the phone and have a reference number for your call. Please see the example of the information that will be returned . Keep in mind that the system will only return information you have specifically requested. For additional eIVR reference material and more information on how to conduct specific transactions with this system, visit the Claims Tips for Health Care Providers page. Use our eIVR system today by calling the Provider Service Unit at (800) 496-5774 from 6 a.m. to 11:30 p.m. Monday through Friday or 6 a.m. to 3 p.m. on Saturdays.



Reminder: Modifier 50 Guidelines for Professional Claims



Modifier 50 is used to report bilateral procedures that are performed during the same operative session. The use of modifier 50 is applicable only to services and/or procedures performed on identical anatomic sites, aspects, or organs. This modifier can be used for diagnostic, radiology, and surgical procedures.

Modifier 50 should not be used when the code descriptor indicates unilateral or bilateral and should not be used when RT and LT would be applicable to the services.

For correct billing, if a bilateral procedure is eligible for bilateral reimbursement, enter the bilateral procedure code with modifier 50 on one line with one (1) unit of service.



New Benefit Enhancement Includes Autism Coverage

January 1, 2010


In addition to the medical coverage provided to all covered children, Blue Cross and Blue Shield of Oklahoma is adding coverage to treat specific types of autism disorders as specified in member contracts. This benefit will apply to fully-insured HMO and PPO group health plans. Coverage will be effective for new groups beginning January 1, 2010. Existing group coverage will be effective at group renewal dates on or after January 1, 2010. Self-funded employer groups may elect to include this new benefit in their health plans.


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