Changes to Behavioral Health Claim Review Coming
In April, we told you beginning Aug. 26, 2019, we are updating our internal review process for behavioral health claims that require benefit preauthorization. Please note that only the claim review process is being updated. The specific services requiring benefit preauthorization and the process for submitting benefit preauthorization requests are not changing.
We need your help to ensure claims are being billed properly. Please remember, for all claims:
- Check eligibility and benefits for each patient prior to rendering services through the Availity® Provider Portal or your preferred vendor portal. This will help you determine if benefit preauthorization is required.
- Receive any required preauthorization before care is rendered.
- Be sure to submit the correct code to expedite claim payment and provide satisfactory customer service for our members.
Submitting claims for our members without the correct benefit preauthorization information may delay payment of your claim. If delayed, you will have an opportunity to submit medical records for a review.
For more information, refer to the Prior Authorization page in the Claims and Eligibility section of our website.
This change does not affect Blue Cross and Blue Shield of Oklahoma (BCBSOK) Federal Employee Program or Medicare members.
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.