BCBSOK Prenotification Request for Maternity and Dialysis Beginning Jan. 1, 2019

December 18, 2018

Effective January 1, 2019, some benefit plans managed by Blue Cross and Blue Shield of Oklahoma (BCBSOK) may request prenotification for members receiving maternity or dialysis services. These members may have additional options for support and care management through their benefit plans, and prenotification assists these members in gaining access to those support program.

When checking eligibility and benefits, you may find some of our members have enrolled in Health Advocacy Solutions and are affected by these changes.

As a reminder, patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit information includes membership validation, coverage status and preauthorization requirements.

To obtain fast, efficient and detailed information for BCBSOK members, please access the Availity® Eligibility and Benefits tool located at . Please note that you must be registered with Availity to gain access to this free online tool. Additional tip sheets are available on the Claims and Eligibility section under Electronic Commerce Services of the BCBSOK provider website.

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.