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Health Care Providers

Blue Cross and Blue Shield of Oklahoma is working with you to keep your patients healthy. We offer our customers access to the most extensive network of health care providers in the state. For more than 67 years, the high-quality care given to our members by our physicians and providers has helped us improve the health of the people we serve. 

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Availity announces batch reporting enhancements

In the spirit of continuous improvement, Availity has used customer feedback to make enhancements to the Immediate Batch Response (IBR) report. Click above to access the entire article.

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Organizational (Type 2) Provider Alert

CMS to deactivate NPIs where NPPES information conflicts with IRS data. Click above to access the entire alert.

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NPI-Only Edit Alerts (June 2008)

This document lists the current edit alerts for electronic claim submitters. For more information, please refer to the Electronic Commerce section.

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Updated Information for Taxonomy Code Use on All Claims

The following statements clarify information regarding taxonomy code usage as published in the May NPI Times:

CMS-1500: We are still suggesting use of the taxonomy code on the CMS-1500 (version 08/05) in fields 17a, 24j, 32b, and 33b.

UB-04: We previously requested that taxonomy codes along with the “ZZ” qualifier be entered in Form Locator 57. Please note that this qualifier and location are incorrect! You may enter the taxonomy code in Form Locator 81, along with the “B3” qualifier.

Remember, the taxonomy code may be used to further identify the billing provider on claims. We are now suggesting that all claim submitters include their taxonomy code.

The entire code set can be found on the Washington Publishing Company (WPC) Web site, at http://www.wpc-edi.com/codes/taxonomy. For further clarification on the UB-04, visit the National Uniform Billing Committee Web site at http://www.nubc.org/ for the UB-04 Official Data Specifications Manuals. For further clarification on the CMS-1500, visit the National Uniform Claim Committee Web site at http://www.nucc.org/.

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Share the NPI(s) you use for Medicare

In the event of crossover claims, Blue Cross and Blue Shield of Oklahoma must have a record of the NPI(s) you use for Medicare claims. Without this information, our system will not be able to recognize you as the billing provider and we will have problems adjudicating these claims.

The fastest way to share your NPI(s) with us is via e-mail at npi@bcbsok.com. Click on the NPI Logo and then select Share it. We will attempt to verify your NPI using the National Plan and Provider Enumeration System registry; however, if your NPI is not found on the NPI Registry, or if the data doesn’t match, then we reserve the right to request submission of your confirmation notice from the Enumerator.

Reminder:
Always submit your claims to Medicare first when Medicare is primary. The BCBS supplemental claims then automatically crossover. The electronic crossover claims have the Explanation of Medicare Benefits information (claim and remittance data) that is needed to process the BCBS supplemental claim.

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Blue Medicare Private Fee-for-Service Terms and Conditions

A Medicare Advantage Private Fee-for-Service (MA PFFS) plan is a plan in which the member may go to any Medicare-approved doctor, ancillary provider, or hospital that accepts the plan’s terms and conditions of participation. Acceptance is “deemed” to occur where the provider is aware, in advance of furnishing services, that the member is enrolled in a PFFS product and when the provider has reasonable access to the Terms and Conditions of participation.

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Electronic Commerce

Welcome to Electronic Commerce Services!

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New phone menu for Medical Services

The Medical Services area phones now have a new menu selection.  Voice activated prompts have been added, but you can also still choose a numbered option.   The phone number for the precertification area is 1-800-672-2378.

To precertify a hospital admission or initiate a new case, call 1-800-672-2378 option 1 or use the voice prompt and say "precertification."

To provide clinical review, call 1-800-672-2378 option 2 or use the voice prompt and say "clinical review."

For case management or home IV infusion, dial 1-800-672-2378 option 3 or use the voice prompt and say "case management."


 

Apply online for Health Check Select and Health Check Basic Call 1-866-303-2583 for more information about individual health insurance