Claims and Eligibility

This section presents an introduction to doing business with Blue Cross and Blue Shield of Oklahoma (BCBSOK), along with an overview of options and resources that may help you maximize administrative efficiencies in your office.

The pages in this section are designed to follow the claim cycle — from the moment a BCBSOK member walks into your office, through processing and payment for covered services you provide.

If you are not yet a contracted provider with BCBSOK, review the How to Join section under the Network Participation tab.

Before You Administer Treatment

Check Member Identification

View a sample of a member identification card

Check BCBSOK Medical Policies

Always consult the approved BCBSOK Medical Policies in the Standards and Requirements. Approved new or revised BCBSOK medical policies and their effective dates are posted on the BCBSOK website the first and fifteenth day of each month. These policies may impact your reimbursement and your patients’ benefits. You may view all active and pending policies, or view draft Medical Policies and provide comments.

Complete All Necessary Precertification Processes

Most HMO and PPO contracts require the member or provider to contact BCBSOK to receive precertification (also known as prior authorization.)

Prior authorization is the determination of the medical necessity and appropriateness of treatment as a required part of the Utilization Management process for certain covered services.

Please visit the Utilization Management page.

Electronic Commerce Solutions

The fastest way to conduct business with BCBSOK throughout the entire claims process is via Electronic Data Interchange (EDI) – the computer-to-computer transmission of standardized information.

Learn more about Electronic Commerce Solutions.

Submitting Claims

To prevent delays, billing errors and other potential setbacks, here are some valuable tips and information to help you manage and submit claims.

Claim Status

After submitting a claim, you can check the status online via Availity Claim Status Tool or your preferred web vendor. By checking claim status, you can verify if your claim has been received, pended or finalized. Additionally, you can verify the descriptions for any claim denials.

Learn more about Claim Status.

Eligibility and Benefits

Patient eligibility and benefits should be verified prior to every scheduled appointment.

Learn more about Eligibility and Benefits.

Interactive Voice Response (IVR) Caller Guides

Medicare Advantage Private Fee-for-Service Terms and Conditions

If you provide care to a Medicare Advantage Private Fee-for-Service (PFFS) member from an out-of-area Blue Cross and Blue Shield (BCBS) Plan, you may use the Web Finder Tool to view the Terms and Conditions  of the member's plan.


In response to the COVID-19 pandemic, Blue Cross and Blue Shield of Oklahoma (BCBSOK) expanded access to telemedicine services to give our members greater access to care. The experience confirmed the importance of telemedicine in health care delivery. Members can access their medically necessary, covered benefits through providers who deliver services through telemedicine. Many of our members also have access to various telemedicine vendors, such as MDLIVE.

Learn more about Telemedicine

Utilization Management

Utilization management review requirements and recommendations are in place to help ensure our members get the right care, at the right time, in the right setting. Learn about the types of utilization management reviews – prior authorization, predetermination and post-service review Learn More.