Prior Authorization / Concurrent Review
Blue Cross and Blue Shield of Oklahoma (BCBSOK) requires prior authorization for all inpatient admissions for all lines of business. If the admitting physician obtained prior authorization for a planned inpatient admission, BCBSOK does not need concurrent review if the patient is discharged within the pre-approved length of stay.
If it is determined the patient will need to stay longer than the pre-approved number of days, the facility is responsible to contact our Medical Services Department with concurrent review information (prior to the initial length of stay expiring) in order for the additional days to be considered for payment. Information necessary to provide at the time of the call is listed below.
- Why was the patient admitted?
- What is being done for the patient?
- What is the level of care needed for the patient?
- What is the expected length of stay?
Once the Medical Services staff receives notification of admission and/or concurrent review information, they will give the provider or facility a determination of whether the inpatient admission can be approved. Approval is dependent upon benefit plans and medical necessity determination. For any additional questions or to request prior authorization or concurrent review please call the Medical Services Department at 1-800-672-2378.