Provider News and Updates
Blue Cross and Blue Shield of Oklahoma is working with you to keep your patients healthy. We offer our customers access to the most extensive network of health care providers in the state. For nearly 70 years, the high-quality care given to our members by our physicians and providers has helped us improve the health of the people we serve.
Care Comparison Tool Offers Data Transparency
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. The Care Comparison tool is available to all BCBSOK members and providers on our Web site at www.bcbsok.com.
In our ongoing initiative to enhance transparency — availability and accessibility — of Care Comparison data, a Flash demo will be added in April 2010 to assist members with their navigation and procedure searches. Additionally, the number of inpatient and outpatient procedures displayed will increase from 35 to 54. The data reported will cover procedures performed from July 1, 2008, through June 30, 2009, paid through Sept. 30, 2009.
BCBSOK is committed to sharing information with our members that is useful, accessible and easy to understand. We believe that a well-informed consumer will make better health care decisions. Watch the "News and Updates" section of our Health Care Providers Web site at www.bcbsok.com/providers.html for additional announcements and information regarding this and other BCBSOK initiatives.
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 Jan. 1 through Jan. 18, 2010. This issue has been resolved effective Jan. 19, 2010. View more information about this issue 
.
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 .
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. View specifics on the Walmart changes and instructions .
Provider Library Now Available Online
For your convenience, a Provider Library has been created to allow provider's continual access to ongoing information. Provider tools, tutorials, claim tips, newsletters, and interactive voice response (IVR) tips are all available in the Provider Library. Visit the Provider Library today!
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.
Previously, all BCBSOK claims were assigned a 17-digit (numeric only) claim number, also known as the Document Control Number (DCN). In the future, claim number assignments will include a combination of 17 alpha and numeric characters, with the alpha character appearing within the 11th through 15th positions of the DCN sequence. (Letters such as "I" and "O" will not be used, since they look similar to numbers.)
You will see the new claim number sequence on your Provider Claim Summary (PCS), Electronic Payment Summary (EPS) and Electronic Remittance Advice (ERA), ANSI X12 835. If you are currently receiving a Daily Payer Report (DPR), you will see the new claim number sequence on this report as well.
The DCN allows us to track and manage inventory as the claim is processed. When you call BCBSOK with questions on a particular claim — including Medicare Crossover claims — it is important to reference this claim number so that we can research and assist with any inquiries you may have.
Benefit and Eligibility Information Available by Fax
You spoke. We listened.
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 Provider Library. 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
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.
This new benefit will cover children under six years of age for the following Autism Spectrum disorders:
- Autistic Disorder (Childhood Autism, Infantile Psychosis and Kanner's Syndrome)
- Childhood Disintegrative Disorder (Heller's Syndrome)
- Rhett's Syndrome
- Specified Pervasive Developmental Disorders (Asperger's Disorder, Atypical Childhood Psychosis and Borderline Psychosis of Childhood)
Benefits are limited to $25,000 per Benefit Period and $75,000 lifetime maximum per subscriber.
For more information, contact the Provider Inquiry Unit at 1-800-496-5774 or call the number on the back of the members ID card.
Note: This is not a contract and is only a brief description of some of the plan benefits. This information is not intended nor does it modify the terms of any agreement in any way. It is intended as a source of general information only.
Availity Health Information Network Maintenance
The Availity Health Information Network will be unavailable due to scheduled system maintenance beginning Saturday, December 5, 2009, at 4 p.m. (CST) until Sunday, December 6, at 11 a.m. We apologize for any inconvenience.
Billing Dispute External Review Process (BDERP)
Effective November 21, 2009, Medical Doctors/Doctors of Osteoparth (MDs/DOs) may file a Post-Service Provider Appeal to resolve disputes limited to the application of coding and payment rules and methodology related to Claims Adjudication Guidelines, bundling, modifiers, etc. Blue Cross Blue Shield of Oklahoma's Internal Appeal process must be exhausted before an External Appeal will be considered. The Provider Appeals are conducted by an Independent Review Organization, MES Solutions.
An appeal can be submitted via web, fax or mail. The guidelines for submitting an Appeal an the applicable fees can be found on MES Solutions' Web site.
Newly Designed Public Web Site Launched
New public tools and resources focus on guidance and support
More than ever, it is important for your patients to understand their health insurance. Our www.bcbsok.com Web site redesign, launched in mid-December, focuses on providing this guidance and support.
In addition to secure access to customized information through Blue Access® for Members, your Blue Cross and Blue Shield of Oklahoma patients will now also have access to publicly available tools and resources to help them navigate the often-complex world of health insurance:
- Searching for a doctor is now easier. The Find a Doctor section is more prominently located in the center of the homepage.
- The Glossary section provides definitions of health insurance words and phrases.
- The Getting Started tutorial makes health insurance easy to understand with articles, shopping guidelines and tips on how your patients can get the most out of their health plan.
- The Health and Wellness section provides informative articles on coping with illnesses, preventive care, exercise, diet, behavioral health and more.
- The Plans For Different People section is a guide that helps your patients identify health care coverage that best matches their needs.
- New-straightforward content helps make health insurance more understandable.
Early testing results from members and health care consumers have been overwhelmingly positive. More than 90 percent of users were able to complete tasks easily and with confidence. Most users felt comfortable with the new site architecture. Feedback on the new consumer education areas revealed that the information was trusted and that it would be helpful when making a decision about health insurance.
The changes to our Web site represent our commitment to help consumers as they shop for health insurance, and add value for our members who use online tools and resources.
As always, we value your opinion. Go to www.bcbsok.com, browse the Web site and click on Feedback [+] to let us know what you think.
New Administration of Maternity Program
Beginning in late November 2009, the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Special Beginnings® * maternity program will be managed internally by program staff in our Health Care Management Division instead of through the independent contractor Alere that had previously managed the program.
To avoid disruption in continuity of care, Alere representatives will continue to service current program participants until they have completed the program. BCBSOK will service all new program enrollees beginning November 23, 2009.
BCBSOK believes this change will allow for better service to our members and offer a more complete picture of their health. Our staff will be enabled to better manage their care and provide:
- Postpartum screening for all participants and follow-up care for positive post-partum depression screens
- Case management services for high-risk pregnancies
- Referral to condition management programs as necessary
- Co-management opportunities for lifestyle management issues
- Early case management identification and intervention for pre-term babies
Help your pregnant patients and their babies get off to a healthy start! Have your patient call (888) 421-7781, 8 a.m. to 6:30 p.m., CT, to enroll in the program.
* BCBSOK reserves the right to discontinue or change this program at any time without notice. Special Beginnings can help plan and manage a member's health, but is not a substitute for medical or other professional advice.
Thomas-Love Settlement Provision 7.8(d) - Significant Edits
The following significant edits are posted in compliance with the Thomas-Love Settlement.
Significant edits [As of 11/03/09]
The significant edits posted on Jan. 9, 2009 are also available for view.
Significant edits [Originally posted on 1/9/09]
Provider Claim Summaries to Be Generated on All Adjustments
Currently, when a claim is adjusted and no additional payment is made, a Provider Claim Summary (PCS) is not generated. We are pleased to report that, beginning in November, a PCS will now be issued in all instances when a claim is adjusted.*
This enhancement is the result of feedback received from the provider community. Your comments helped make us aware of situations where our members could be responsible for deductible, coinsurance or non-covered services if claim adjustments resulted in patient/member liability changes. These instances were previously not communicated to the provider, as no PCS was issued.
Once the new functionality is implemented in November, you will be able to identify revised Patient Share amounts resulting from adjusted claims. This change should help avoid confusion on the part of our members, in addition to assisting your staff with patient account reconciliation.
* Exception: A PCS will not be generated in Request for Claim Refund (RFCR) situations.
Paper to Electronic (PCS to EPS) Transition Reminders
If your office is enrolled for the Electronic Remittance Advice (ERA), you are automatically enrolled to receive the Electronic Payment Summary (EPS). The
EPS contains the same information as your paper Provider Claim Summary (PCS); however, the EPS arrives faster and offers easier archiving and retrieval capability. Learn how you can be prepared for this paper to electronic transition process .
Code Auditing Upgrade and Modifier 59 Exempt Auditing
Changes will be made to Blue Cross and Blue Shield of Oklahoma's claims processing system that affects its bundling logic. Please click here for more details on this update, which will occur on or about January 19, 2010 .
H1N1 Information for Providers
With the impending delivery of the new vaccine for the novel A H1N1 flu virus, Blue Cross and Blue Shield of Oklahoma (BCBSOK) wants to make our network physicians aware of our policy concerning coverage of charges for administering the vaccine for BCBSOK members. Click here to learn more about the charges and codes related to the H1N1 virus .
Please be advised that effective October 19, 2009 our 835 (ERA) files will no longer contain the Payee Additional Identification (REF*PQ) segment. This segment is located at the Header Level, Loop 1000B.
Availity's New Claim Research Tool Now Available
Availity's new online Claim Research Tool (CRT) provides your office staff greater claims accuracy and increased office efficiency in managing your account receivables. The CRT gives your staff fast, real-time access to enhanced Blue Cross and Blue Shield of Oklahoma claim status information, with features that include:
- Status of multiple claims in one view
- Member ID and claim (DCN) number look-ups
- Patient account and group number information
- Detailed line-level information including reason codes and descriptions
- Related copay, deductible, and coinsurance amounts
The CRT also ends the need for costly, time-consuming phone calls. The tip sheet makes using this great new tool a breeze. Best of all, CRT delivers all of the above at no cost to you!
Availity is a registered trademark of Availity, L.L.C., an independent, third party vendor.
Prior Authorization / Concurrent Review
Blue Cross and Blue Shield of Oklahoma (BCBSOK) requires prior authorization for all inpatient admissions for all lines of business. If the admitting physician obtained prior authorization for a planned inpatient admission, BCBSOK does not need concurrent review if the patient is discharged within the pre-approved length of stay. If it is determined the patient will need to stay longer than the pre-approved number of days, the facility is responsible to contact our Medical Services Department with concurrent review information (prior to the initial length of stay expiring) in order for the additional days to be considered for payment. Click here to learn more .
If you are a facility that files claims on a UB-04 claim form, please remember to follow the guidelines listed in the current UB-04 Editor .
When you have a different billing and physical address, please use Box 1 to list your physical address and Box 2 to list your billing address. This helps to expedite claims processing and ensure there is no confusion as to where the services were rendered.
This user guide will also assist you with identifying the fields that are required to be completed per our claims processing guidelines and help to eliminate unnecessary claim delays.
Learn How to File Unlisted Procedure Codes (NDCs) Electronically
Are you interested in filing your unlisted procedure codes for drugs and injections electronically? Click here to learn how .
Claims and Correspondence Address Reminder
In an effort to provide our customers with timely and accurate claims processing service, please remember to submit all claims and correspondence to the following P. O. Box address:
BlueCross BlueShield of Oklahoma
P.O. Box 3283
Tulsa, OK 74102-3283
This address is the same for all lines of business and will allow us to better serve you in a timely manner.
If any other documentation other than the original claim submission is being sent to the above address, please remember to attach the Provider Claim Appeal/Reconsideration Review Request Form located on our Web site.
Taxonomy codes are administrative codes set for identifying the provider type and area of specialization for health care providers. Each taxonomy code is a unique ten character alphanumeric code that enables providers to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual provider and organizational provider level. Click here to learn more helpful information about taxonomy codes .
