 |
CONTACT US CAREER OPPORTUNITIES |
       
|
|
Provider News & UpdatesBlue 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 more than 68 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. _______________________________________________________ Public Web Site Redesign Coming Soon More than ever, it’s important to help your patients understand health insurance and find a plan to meet their needs. Our www.bcbsok.com redesign, set to launch in early December, will focus on providing this guidance and support. In addition to continuing to have secure access to customized information through Blue Access® for Members, your patients will now have access to publicly available tools and resources to help them navigate the often-complex world of health insurance. Changes to our site include:
These public Web site enhancements represent our commitment to add value for your patients who use our online resources and to help consumers as they shop for health coverage.
In early December, when the new Web site launches, we will notify you through www.bcbsok.com. We look forward to your feedback.
_______________________________________________________ Blue Cross Blue Shield of Oklahoma (BCBSOK) will be performing an internal system upgrade. This Professional Claim(s) upgrade will take place this week-end Nov. 14-15, 2009. The enhancement allows for the implementation of the new Document Control Number (DCN) or Claim Number(s) format, which is assigned by BCBSOK, to include a combination of 17 alpha and numeric characters, with the alpha character appearing within the 11th through 15th positions of the number sequence. This DCN/Claim number sequence will appear on your Delayed Payer Report (DPR), Electronic Remittance Advice (ERA), Electronic Payment Summary (EPS) as well as your Provider Claim Summary (PCS). This upgrade may possibly cause your Delayed Payer Reports (DPR) to be deferred anywhere between 24 and 48 hours for this week-end implementation only. We apologize for any convenience this may cause you.
_______________________________________________________ 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:
Help your pregnant patients and their babies get off to a healthy start! Have your patient call (888) 421-7781, 8 a.m. – 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. _______________________________________________________ Downtime alert for RediLink Product Systems Blue Cross and Blue Shield of Oklahoma will be performing a scheduled maintenance/upgrade to our network as part of our efforts to continually improve access and reliable production environment. The SUNFTP1/2 RediLink Production Systems will be unavailable as this will require a shutdown of these systems. This upgrade will affect all FTP and AS2 customers. Dialup customers should not be affected. The upgrade is scheduled from 11 p.m. on Nov. 7, 2009 until 1 p.m. on November 8, 2009 (14 hours). Click here for more information. _______________________________________________________ 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] _______________________________________________________ Coming Soon: 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 _______________________________________________________ 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:
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 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 website at http://www.bcbsok.com/forms.html. _________________________________________________ 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. _________________________________________________ Tips for Preventing Claim Delays _________________________________________________ Electronic Refund Management (ERM) is now available This online refund management tool will help simplify overpayment reconciliation and related processes. The ERM application is available at no additional charge. Click here for more information. _________________________________________________ Coming Soon: Discontinuance of the Paper Provider Claim Summary (PCS) In previous alerts, we notified you that upon enrollment for the Electronic Remittance Advice (ERA) and Electronic Payment Summary (EPS), you would continue to receive your paper Provider Claim Summary (PCS) for 30 days after the start of your ERA and EPS files. Please accept this as our notification that in the near future, BCBSOK will discontinue producing the paper PCS for all providers that have been receiving the ERA and EPS for at least 30 days. If you have questions or need additional information, please contact the Electronic Commerce Center at (800) 746-4614.
|
| HOME |
HEALTH & WELLNESS |
PRIVACY / LEGAL / FRAUD PREVENTION
MEDICARE PLANS AND SERVICES | SITEMAP |