What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements that may apply to some commercial members to reflect new, replaced or removed codes. These changes are based on updates from Utilization Management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System (HCPCS) changes from the Centers for Medicaid & Medicare Services. A summary of changes is included below.
Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Changes are:
· July 1, 2023 – Addition of Medical Oncology codes to be reviewed by Carelon Medical Benefits Management (Carelon) formerly AIM Specialty Health
· July 1, 2023 – Replacement and removal of Musculoskeletal Joint and Spine codes reviewed by Carelon
· July 1, 2023 – Addition of Genetic Testing codes to be reviewed by Carelon
· July 1, 2023 – Replacement of an Infusion Site of Care drug code to be reviewed by BCBSOK
· July 1, 2023 – Addition of Advanced Imaging codes to be reviewed by Carelon
Also, Effective May 14, 2023, enhancements to Carelon’s ProviderPortal will create an easier intake process for its Medical Oncology program. Register for a free training from Carelon below:
· Tuesday, May 16, 12 noon CST Register for webinar at this link
· Thursday, August 10, 2 p.m. CST Register for webinar at this link
· Tuesday, November 14, 2 p.m. CST Register for webinar at this link
General Training Reminder:
Contact your Network Representative for additional training on using the Carelon ProviderPortal.
More Information: For a revised list of codes, go to our provider website in the preauthorization section.
Note: Effective April 1, 2023, the prior authorization list will include a link to the medical policy website for review of the specific medical policies associated with the procedure code rather than listing the medical policy number and title for each code. The list will continue to include information on whether prior authorization for the procedure code is managed by BCBSOK or Carelon.
Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
CPT copyright 2022 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Carelon Health Benefits Management (Carelon) is an independent company that has contracted with BCBSOK to provide utilization management services for members with coverage through BCBSOK.
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.