At Blue Cross and Blue Shield of Oklahoma (BCBSOK), we are committed to providing support to physician practices. We've designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.
Availity® Authorizations & Referrals
Authorizations & Referrals is an online tool in the Availity Provider Portal that allows you to submit preauthorization and/or referral requests handled by Blue Cross and Blue Shield of Oklahoma (BCBSOK). Learn More.
Availity® Attachments: Submit Predetermination of Benefits Requests Online
Attachments is an online tool in the Availity Provider Portal that allows you to submit electronic predetermination of benefits requests handled by Blue Cross Blue Shield of Oklahoma (BCBSOK). Learn More
Availity Eligibility and Benefits
It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.
To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.
For additional details refer to the Availity Eligibility and Benefits User Guide.
You must be registered with Availity to gain access to this and other online resources offered by Availity.
Provider Data Management (PDM)
Provider Data Management (PDM) is a web-based tool in Availity Essentials that allows professional providers to quickly update, validate and attest to the accuracy of their information on file with Blue Cross and Blue Shield of Oklahoma (BCBSOK). Learn more.
Social Determinants of Health Screening Tool
Social determinants of health are conditions in the environments where people live, learn and work that affect a wide range of health and quality-of-life outcomes and risks.
Blue Cross and Blue Shield of Oklahoma wants to help you identify patients that may need assistance with social factors that impact their health.
Please use this Social Determinants of Health Screening Tool to determine if your patient may need additional assistance.
For more information and additional resources visit 211.org.
Responding to Quality and Risk Adjustment Medical Record Requests Online via AvailityTM Web Portal
The AvailityTM Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from BCBSOK. Beginning Feb. 15, 2018, providers can upload and submit the necessary medical records to BCBSOK using the Medical Attachment option in the Claims & Payments menu through the Availity Web portal. Learn More.
BlueApprovR is an online tool accessible in Availity® Essentials that allows providers to submit prior authorization requests and check status for specialty pharmacy drugs and behavioral health clinical evaluation for many BCBSOK commercial members. Learn More.
BCBSOK, in partnership with the Blue Cross and Blue Shield Association, has developed Blue Distinction Centers. Each Center has been selected through a rigorous, evidence-based, objective selection criteria established with input from medical experts and organizations.
Blue Distinction is a nationwide program that will create an unprecedented level of healthcare transparency with two goals: engaging consumers to enable more informed healthcare decisions and collaborating with providers to improve quality outcomes and affordability.
To learn more about the program, selection criteria, and designated centers in each state, visit Blue Distinction for ProviderSM.
Bridges to Excellence
BCBSOK is licensed as a sponsor of the Bridges to Excellence® (BTE) Diabetic Care Recognition program and Cardiac Care Recognition programs. Learn More.
Patient Cost Estimator
The Availity® Patient Cost Estimator (PCE)tool provides real-time estimation of member responsibility. This feature can be utilized at the time of service, enabling professional providers to collect copayments, coinsurance and deductible amounts up front for BCBSOK members. Learn more.
Claim Inquiry Resolution (CIR) Tool
The Claim Inquiry Resolution tool can be accessed via a tab in our Electronic Refund Management (eRM) system. The CIR tool allows you to communicate online with our Customer Advocates in some situations where previously a call or letter was required. Learn more.
Claim Status Tool
The Availity® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSOK. Learn more
Clear Claim Connection
Clear Claim Connection is a Web-based code auditing reference tool that mirrors BCBSOK edits (i.e., unbundling, mutually exclusive, and incidental). Learn more.
Clinical Quality Validation (CQV) Application
Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSOK members using CQV. Learn more.
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Oklahoma (BCBSOK) pharmacy PA program. Learn more.
Electronic Claim Submission via Availity® Provider Portal
Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of Oklahoma (BCBSOK), at no cost. Learn More.
Electronic Clinical Claim Appeal Requests via Availity®
The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Learn More.
Electronic Refund Management (ERM)
This online refund management tool will help simplify overpayment reconciliation, as well as related processes and transactions. Use the ERM tool now.
Fee Schedules via Availity® (Professional Providers)
The Availity Fee Schedule viewer tool allows professional providers participating with BCBSOK to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Learn more.
Manage My Organization via Availity® Essentials
Manage My Organization in the Availity Essentials portal allows administrators and users to add provider(s) within your organization(s) or edit existing ones, for easy data entry when submitting transactions handled by Blue Cross and Blue Shield of Oklahoma (BCBSOK). Learn more.
Medical Record Status Viewer
The Medical Record Status Viewer is an online application that allows providers to confirm receipt of up to four of the most recent medical records submitted by mail or fax to Blue Cross and Blue Shield of Oklahoma (BCBSOK) for claim processing and prior authorization requests. Learn more.
Message This Payer Application
The Message This Payer application in Availity® Essentials allows providers to send secure messages to Blue Cross and Blue Shield of Oklahoma (BCBSOK) for claim management questions and follow along with the conversation history. Learn more.
National Drug Code (NDC) Units Calculator Tool via Availity®
The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units. Learn More.
Patient Care Summary®
Patient Care Summary is a user-friendly, electronic health record that assists health care professionals in making informed treatment decisions for their patients. It's available free of charge to physicians and provider organizations registered with Availity in Oklahoma. To register, visit availity.com, or call Availity Client Services at (800) AVAILITY (282-4548). Learn more about Patient Care Summary.
Patient ID Finder
The Availity® Patient ID Finder tool allows providers to obtain the BCBSOK member ID number and group number by entering patient-specific data elements. Learn More.
The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSOK in the 835 Electronic Remittance Advice (ERA). Learn More.
The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Learn More.
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 any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
Verification of eligibility and/or benefit information 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, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.