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Standards and Requirements
- Standards and Requirements
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Consolidated Appropriations Act & Transparency in Coverage Final Rule
- Medical Policies
- Medical Policy and Prior Authorization: Out-of-area Members
- Provider Reference Manuals
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Reimbursement Policies
- Access to Care Standards
- Medical Record Documentation Standards
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- Company Information
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Availity® Essentials
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Oklahoma, obtaining claim status, viewing provider claim summaries and more. Learn more, register or log on: Availity Essentials
Availity Client Services: 800-282-4548
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Availity Authorizations & Referrals
Availity’s Authorizations tool (HIPAA-standard 278 transaction) allows the electronic submission of inpatient admissions, select outpatient services and referrals handled by BCBSOK.
To access and use Availity Authorizations: log in to Availity.com
For more info visit our Availity Authorizations & Referrals page -
Behavioral Health Unit
For information about our Behavioral Health program
(Includes prior authorization)800-672-2378
Fax: 877-361-7660BCBSOK BH Unit
PO Box 660239
Dallas, TX 75266-0240 -
BlueCard® Hotline
For out-of-state member benefits and eligibility 800-676-BLUE (2583)
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Care Management Programs
855-462-1781
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Carelon Medical Benefits Management
Submit prior authorization requests to Carelon by phone or through the Carelon ProviderPortal site 800-859-5299
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Claims Mailing Addresses
Claims Mailing Address
For Commercial Claims:
Blue Cross and Blue Shield of Oklahoma
P.O. Box 655924
Dallas, TX 75265-5924For Initial Paper Medicare Claims:
Blue Cross Medicare Advantage
C/O Claims Department
PO Box 3686
Scranton, PA 18505
Payer ID: 66006
For Medicare Advantage Inquiries:
Blue Cross and Blue Shield of Oklahoma
PO Box 4555
Scranton, PA 18505Oklahoma City Office
Blue Cross and Blue Shield of Oklahoma
3817 Northwest Expressway
Suite 300
Oklahoma City, OK 73112
(918) 560-3500Tulsa Office
Blue Cross and Blue Shield of Oklahoma
1400 S. Boston
Tulsa, OK 74119-3613
(918) 560-3500 -
Dental Benefits Customer Service (Commercial only)
888-381-9727 (Monday through Friday, 8 a.m. to 6 p.m. CT.)
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Dental Network of America
888-381-9792 -
Electronic Commerce (E-Commerce) Center
For information about EDI (Electronic Data Interchange) transactions, such as electronic claim submission Email questions -
Evicore healthcare
To obtain benefit prior authorization for certain care categories.
855-252-1117
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Federal Employee Program®
To verify eligibility and benefits and/or check claim status for FEP® members
FEP Behavioral Health Line
800-722-3130
877-906-6389
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Fraud Hotline
To report concerns to the BCBSOK Special Investigations Department (SID) 800-543-0867
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Medical Management Correspondence for Exchange Members
866-589-8254
Blue Cross Blue Shield of Oklahoma
Medical Care Management
P. O. Box 660712
Dallas, TX 75266-0712 -
Medical Services
For pre-certification of inpatient hospital admissions, including acute care, inpatient rehab, skilled nursing, long-term acute care, inpatient hospice, and coordinated health care such as skilled nursing visits, IV medication, etc. 800-672-2378
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Medicare Advantage
Medicare Advantage Provider Customer Service
Individual plan phone 877-774-8592 Group plan phone 877-299-1008 Medicare Advantage Claims Payments and Appeals
Electronic claims (preferred) Availity® Essentials or your preferred vendor
Electronic payer ID 66006
Paper claims Blue Cross Medicare Advantage
c/o Provider Services
PO Box 3686
Scranton, PA 18505Medicare Advantage Claims Payments and Appeals
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. Learn more, register or log on: Availity Essentials
Availity Client Services: 800-282-4548
Prospective and Concurrent Medical Appeals
Who can request a medical appeal: Member, member's authorized representative, contracted providers or noncontracted providers
Standard appeals fax 1-800-419-2009 Expedited appeals fax 1-800-338-2227 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 7526Retrospective Medical Appeals
Who can request a retrospective medical appeal: Member, member's authorized representative or noncontracted providers
Standard appeals fax 1-800-419-2009 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 75266Provider Disputes
Who can request a provider dispute: contracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address
Blue Cross Medicare Advantage
c/o Provider Disputes
PO Box 4555
Scranton, PA 18505Provider Claims Disputes
Who can request a provider claims dispute: Contracted and noncontracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address Blue Cross Medicare Advantage
Attn: Provider Claims Disputes
PO Box 4555
Scranton, PA 18505Grievances
Who can file a grievance: Member or member’s authorized representative
Grievance fax 1-855-674-9189 Mailing address Blue Cross Medicare Advantage
Attn: Grievances
PO Box 4288
Scranton, PA 18505Medicare Advantage Utilization Management
Availity Authorizations & Referrals Electronically submit prior authorization requests
Prior authorization requirements for Medicare Advantage EviCore healthcare prior authorization Prior authorization and out-of-network referrals Phone: 877-774-8592
Fax: 855-874-4711 -
Prior Authorization of Medical Services for Exchange Members
For pre-certification of inpatient hospital admissions, including acute care, inpatient rehab, skilled nursing, long-term acute care, inpatient hospice and coordinated health care such as skilled nursing visits, IV medication, etc. 800-672-2378
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Provider Access and Servicing Strategy Unit
For more information on provider education opportunities, visit the Provider Training page or send an email. -
Provider Inquiry Unit
For general assistance on a variety of topics, such as products, claims review requests, claims address, etc. 800-496-5774 -
Provider Learning Opportunities
Complimentary training for participating providers, billing services, clinical and administrative staff who are new or already participating in our network. To register, visit the Provider Training page. -
Provider Relations
For information on how to use online tools, products and initiatives, provider education opportunities and personalized office visits, call or email. 800-722-3730, Option 2
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Carelon Medical Benefits Management is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.
eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSOK.