Print

BCBSOK Expansion or Changes to Preauthorization Requirements Beginning Jan. 1, 2019

December 4, 2018

Effective Jan. 1, 2019, benefit plans managed by Blue Cross and Blue Shield of Oklahoma (BCBSOK) will be updating preauthorization requirements.

You should verify patient eligibility and benefits prior to every scheduled appointment. Eligibility and benefit information includes membership validation, coverage status and preauthorization requirements. To obtain fast, efficient, detailed information for BCBSOK members, please access the Availity® Eligibility and Benefits tool . Please note that you must be registered with Availity to gain access to this free online tool. Additional tip sheets are available on the BCBSOK provider website.

Below is a list of the newly impacted care categories that may need preauthorization for various networks effective Jan. 1, 2019:

  • Molecular and Genetic testing
  • Radiation Therapy
  • Advanced Imaging
  • Cardiac Imaging
  • Musculoskeletal Joint and Spine Surgery
  • Pain Management
    • Joint and Spine Surgery
    • Select Outpatient Procedures
  • Medical Benefit Specialty Pharmacy

It is imperative that providers check member eligibility and benefits and verify preauthorization requirements through Availity or their preferred vendor.

A 2019 list of services that may require preauthorization or prenotification is available. Not all requirements apply to every BCBSOK plan. Watch for future detailed updates, as well as available training sessions, on bcbsok.com/provider.

Please feel free to contact your Provider Network Representative if you have any questions or if you need additional information.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. Aerial, iExchange and Medecision® are trademarks of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSOK makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits, is not a guarantee of payment. Benefit determination will occur when a claim is received and will be based other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services when rendered.