July 31, 2026
What are some requirements of the MyBlue HMO benefit plan?
- MyBlue HMO members must choose a primary care provider who is participating in the MyBlue HMO network. The PCP can be a family practitioner, OB-GYN, pediatrician, internist or physician assistant or advanced practice nurse in one of those areas of practice. The physician assistant and advanced practice nurse must be associated with the PCP on a full-time basis.
- The MyBlue HMO PCP directs the member’s care for specialists, hospitals and other providers to BCBSOK, including submitting referrals for specialists. Refer to Availity® Authorizations & Referrals for information on which member procedures require referrals.
- In-network PCPs and specialty care providers who have obtained a referral are responsible for obtaining prior authorization when it may be required. If prior authorization is not obtained for the applicable services, the claim is at risk of being denied. The claim for facility and professional services is also at risk of being denied.
- The member may see an in-network OB-GYN without obtaining a referral. The OB-GYN can order other services or obtain prior authorization for additional services.
- To help ensure timely and accurate claim processing, please include your referral number and the name of the referring and attending physician on your claim form.
- In-network behavioral health providers do not require an approved referral from the MyBlue HMO PCP for outpatient services.
- MyBlue HMO members do not have coverage for services provided by out-of-network providers except for emergencies, unless authorization is obtained.
To locate in-network facilities and professional providers for MyBlue HMO members, visit the provider directory.
How do I verify eligibility and benefits for MyBlue HMO members?
Verify eligibility and benefits prior to every scheduled appointment through Availity Essentials or your preferred web vendor. Eligibility and benefit quotes include participant confirmation, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. When services may not be covered, participants should be notified they may be billed directly.
How does a PCP submit a required referral for MyBlue HMO members?
MyBlue HMO PCPs are required to submit referral requests for their MyBlue HMO members for services the MyBlue HMO PCP is not able to provide. The referral request should be submitted to BCBSOK and the rendering provider or hospital.
MyBlue HMO PCPs can submit referral requests online using the Availity Authorization & Referrals tool. Refer to the Availity Referrals User Guide to learn about the submission process. Referral requests may also be submitted via fax to BCBSOK at 866-589-8253.
If the MyBlue HMO member’s assigned PCP is not available, is a referral required for the member to see another MyBlue HMO PCP?
If the MyBlue HMO PCP has the same tax ID and the same specialty type, then no referral is required.
Do emergency services require a referral?
No. Emergency services or urgent care visits do not require any prior authorization or referrals.
How can I identify MyBlue HMO members?
Look for the following information on the member’s ID card:
- MyBlue HMO is displayed on the member ID card or dependent ID card.
- MyBlue HMO members have a unique network ID: BAV.
- The MyBlue HMO member’s assigned PCP is displayed on the member ID card.
- The three-character prefix is K2G.
How can I distinguish a MyBlue HMO member from a BlueLincs HMO℠ member?
Look for the following information on a BlueLincs member’s ID card:
- BlueLincs HMO does not require a PCP referral like MyBlue HMO.
- BlueLincs HMO is displayed on the member ID card or dependent ID card.
- BlueLincs HMO members have a unique network ID: HMO.
- The three-character prefix is YUH.
If you have questions, contact your provider relations representative or email us.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
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 any products or services provided by third party vendors.