Discuss Preventive Care with Members

July 16, 2026

Six in 10 adults in the U.S. have a chronic disease, many of which are treatable or preventable when found early, according to the Centers for Disease Control and Prevention. You can help our members by encouraging them to get preventive care, including physical exams and screenings, as appropriate. These may include:

  • Blood pressure and cholesterol level screenings
  • Vaccines
  • Mammogram screening
  • Colon cancer screening
  • Cervical cancer screening 
  • Diabetes screening

Refer to our preventive care guidelines for evidence-based recommendations on primary preventive services. 

Quality care: We track the Healthcare Effectiveness Data and Information Set (HEDIS®) measure Adults’ Access to Preventive/Ambulatory Health Services. It measures the percentage of:

  • Medicaid and Medicare members ages 20 years and older who had one or more ambulatory or preventive care visits during the measurement year
  • Members of commercial plans who had one or more ambulatory or preventive care visits during the measurement year or within the two years prior to the measurement year

Documentation and coding for this measure: Refer to our Quality Care 2026 booklet HEDIS measures for more information. You can access it in Availity® Essentials within our Payer Spaces in the resources section.  

Tips to consider to close care gaps

  • Talk with our members about risk reduction and prevention. Our wellness guidelines for members have recommendations to download and print. 
  • Document screenings and vaccines in the medical record. Indicate the date and results.
  • Consider offering flexible scheduling when possible, including early morning, evening or weekend hours; online self-scheduling; and telehealth options when applicable.
  • Reach out to members who haven't been in for appointments via provider portals, email, phone or text. Follow up with members who miss their appointments.

Checking eligibility and benefits: Check member eligibility and benefits using Availity Essentials or your preferred vendor before every scheduled appointment. Eligibility and benefit quotes include members’ coverage status and other important information, such as applicable copays, coinsurance and deductibles. 

Our qualified health plans cover most in-network preventive health care services with no out-of-pocket costs, depending on the plan’s benefit coverage. Members can find complete details on preventive services their plan covers in their benefit book, or they may call the number on their member ID card. Learn more.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. The information provided does not constitute coding or legal advice. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

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 Blue Cross and Blue Shield of Oklahoma. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

HEDIS is a registered trademark of the National Committee for Quality Assurance.