Print

New Prior Authorization Requirements for Oklahoma Members Effective Jan. 1, 2020

October 10, 2019

There are important changes to the preauthorization requirements for some of your Blue Cross and Blue Shield of Oklahoma (BCBSOK) patients. Beginning Jan. 1, 2020 preauthorization will be required or expanded for:

  • Outpatient provider administered drug therapies, including Cellular Immunotherapy, Gene Therapy and other medical benefit drug therapies.

A list of the Drug Therapies Procedure Codes is posted to the provider website, under the Clinical Resources / Prior Authorization tab.

For services requiring prior authorization through BCBSOK, use iExchange® to preauthorize those services. Refer to the iExchange web page for more information or to set up an iExchange account.

Prior authorization through BCBSOK may also be requested by calling the phone number listed on the BCBSOK member/participant's ID card.

Use Availity® or your preferred vendor to check eligibility and benefits to determine if you are in-network for your patient and whether any prior authorization or prenotification is required. Availity allows you to determine if preauthorization is required. Refer to "Eligibility and Benefits" on the provider website for more information on Availity. You can also refer to the BCBSOK provider website for assistance, including an updated list of services that require preauthorization.

As a reminder, it is important to check eligibility and benefits prior to rendering services. This step will help you determine if benefit preauthorization is required for a particular member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSOK's provider website.

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. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member's ID card.

iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers.

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.

BCBSOK makes no endorsement, representations or warranties regarding any products or services offered by Availity, AIM or Medecision. The vendors are solely responsible for the products or services they offer.