Standards and Requirements


ANSI Version 5010

On Jan. 1, 2012, all HIPAA-covered entities adopted the American National Standards Institute (ANSI) v5010 to promote increased use of electronic data interchange (EDI) transactions between all covered entities. ANSI v5010 is the foundation of health information technology (HIT) and a necessary step to the upcoming conversion to ICD-10.

ANSI v5010 includes more than 850 structural, technical and content changes to the data submitted with electronic claims, as well as the data received in response to other electronic inquiries, such as eligibility and benefits, or claim status.

Questions? Need assistance?

  • Visit the ANSI v5010 Learn more about third-party links section of the Centers for Medicare & Medicaid Services (CMS) website for materials and resources

Clinical Payment and Coding Policies

Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines Millman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Learn more.


ICD-10

ICD-10, the means by which Blue Cross and Blue Shield of Oklahoma (BCBSOK) exchanges member data with providers, will change dramatically over the next several years. Explore ICD-10 changes.


Medical Policies

Medical Policies are based on research that provides evidence of scientific merit for a particular medical technology. In most cases, they are used as guidelines for coverage determinations in health care benefit programs. Explore more about Medical Policies, as well as restriction and limitations .


Draft Medical Policies

Medical Policies are based on scientific and medical research. They are often used as guidelines for coverage determinations in health care benefit programs. Explore Medical Policy drafts that are currently being considered, with an opportunity to provide feedback .


Medical Policy Router (out-of-area members)

Medical Policy Router (out-of-area members)