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Health Care ProvidersBlue 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 67 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.
___________________________________________________________________________ Here’s how: • Use the proper version of the claim form • Include all required information Paper claims that are rejected will be returned to the provider with a cover letter explaining the reason for the return. Follow the instructions on the form to properly resubmit the claim. For more information, click on the NPI logo and refer to our FAQs. ___________________________________________________________________________ Blue Medicare Private Fee-for-Service Terms and Conditions A Medicare Advantage Private Fee-for-Service (MA PFFS) plan is a plan in which the member may go to any Medicare-approved doctor, ancillary provider, or hospital that accepts the plan’s terms and conditions of participation. Acceptance is “deemed” to occur where the provider is aware, in advance of furnishing services, that the member is enrolled in a PFFS product and when the provider has reasonable access to the Terms and Conditions of participation. ___________________________________________________________________________Welcome to Electronic Commerce Services! ___________________________________________________________________________ In the second half of 2007, Blue Cross and Blue Shield of Oklahoma is analyzing claims data for a new performance based recognition program for network health care providers. Performance based recognition is a tool to improve the quality and cost-effectiveness of health care by focusing on outcomes. The program seeks to recognize those physicians whose patients consistently experience positive outcomes in order to emphasize quality of care. The following four measures will be evaluated in 2007: More indicators will be studied in 2008, as the performance based recognition program continues its phased implementation. Watch for additional details about the program on this Web page and in future issues of Network News. New phone menu for Medical Services The Medical Services area phones now have a new menu selection. Voice activated prompts have been added, but you can also still choose a numbered option. The phone number for the precertification area is 1-800-672-2378. To precertify a hospital admission or initiate a new case, call 1-800-672-2378 option 1 or use the voice prompt and say "precertification." To provide clinical review, call 1-800-672-2378 option 2 or use the voice prompt and say "clinical review." For case management or home IV infusion, dial 1-800-672-2378 option 3 or use the voice prompt and say "case management." ______________________________________________________________________________ Availity Health Information Network provides access to Blue Cross and Blue Shield of Oklahoma’s eligibility and benefits, and claim status. All information previously accessible on Blue Cross and Blue Shield of Oklahoma’s provider online services site is available on the Availity Health Information Network. Enhanced features and full functionality of Availity’s services will continue to be added throughout 2007. For more information, contact your Availity representative listed below or your Blue Cross and Blue Shield of Oklahoma health industry relations representative. Eastern Oklahoma, contact Carmen Bellew at (918) 599-9527 or carmen.bellew@availity.com Letter for Submitters - Electronic Claim Requirement Information
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