Blue Review Provider Newsletter

Our Blue Review provider newsletter is released monthly so that you and your staff have the latest news on claims and billing, federal mandates, medical policies, condition management programs, practice guidelines, formulary/drug list updates, BlueCard and educational webinars.

To receive the Blue Review provider newsletter please click on the Receive newsletter by email link under Related Resources or fill out the Change Existing Demographic Information form and include your email.

November 2024

  • Out‑of‑State Care Beyond Contiguous Counties Is No Longer Covered Benefit
  • Updates Coming to Behavioral Health Substance Abuse Criteria for Utilization Management
  • Prior Authorization Codes Are Changing for Some Commercial Members
  • Risk Identification and Outreach Program Supports Member Safety
  • Remind Our Members That the Flu Vaccine Can Reduce Risks
  • Encourage Annual Eye Exams for Members with Diabetes
  • Care Coordination May Help Our Members after Hospital Discharges
  • Code Effectively to Earn Additional Incentive Payments on Medicare Advantage Claims
  • Members May Pay Drug Costs Monthly with New Medicare Prescription Payment Plan
  • Check ID Cards for New Coupe Health Plan Members
  • Members Value Open Communication from Their Providers
  • Select Self‑Administered Drugs Moving to Pharmacy Benefit
  • Pharmacy Program Quarterly Update Changes – Part 2

October 2024

  • Acquisition of Cigna Healthcare Medicare Business in 2025
  • Utilization Management Expanding to Include Site of Care Review of Advanced Imaging for Some Commercial Members
  • Submit Paper Commercial Claims to Correct PO Box to Avoid Delays
  • Use the Updated Claims Referral Form for American Indian/Alaska Native Limited Cost-Share Plans
  • ClaimsXtenTM Quarterly Update
  • Breast Cancer Screening Begins at Age 40
  • Child and Adolescent Weight Assessment and Nutrition Counseling Can Help Close Care Gaps
  • In‑home Test Kits Help Our Members Manage Their Kidney Health
  • Register for a Coding Webinar on Coagulation Defects and Other Hematological Disorders
  • Learn What Members Say They Want from Their Health Care Professionals

September 2024

  • Physician Performance Insights Reports Are Now Available
  • Watch for Our Provider Advisory Survey
  • Shared Decision‑Making Aids Can Help Guide Care Choices
  • Earn Continuing Education Credit at Maternal Mental Health Webinar
  • Register for Webinars on Coding for Cancers, Stroke and Heart Failure
  • Encourage Medicare Members to Respond to Health Outcomes Survey
  • 30‑Day Supply Limit: Select Commercial Members Have New Pharmacy Benefit for GLP‑1 or Anti‑Obesity Drug Therapy
  • Pharmacy Program Quarterly Update Changes Effective Oct. 1, 2024 – Part 1
  • Medical Policy Updates

August 2024

  • Has Your Information Changed? Update Us and the NPI Registry
  • Medicare Providers May Treat Members of Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Reminder: Statewide Fee Schedule Update
  • Check Prior Authorization Requirements for Procedure Codes through Availity® Essentials or Our IVR System
  • Provider Finder® to Rank Providers to Help PPO Members Find Care
  • ClaimsXtenTM Quarterly Updates

July 2024

  • Coming Soon: 2024 Provider Availability and Access Survey
  • Earn Continuing Education Credit: Webinar on Avoiding Inappropriate Antibiotic Use
  • Physician Performance Insights Reports Coming in August from PEAQSM
  • Pharmacy Program Quarterly Update — Part 2 Changes Effective July 1, 2024
  • New Coupe Health Plan: Update Your Member Records
  • GLP-1 New to Therapy Optional Benefit Program Available for Select Commercial Members
  • In-Home Test Kits for Colorectal Cancer Screening
  • Encourage Routine Vaccines and Well-Care Visits for Children and Teens
  • Provider Rights and Responsibilities
  • Member Rights and Responsibilities
  • Cultural Awareness Webinars: No-Cost Continuing Education Credit
  • See Our Revised Coding for Consultation Services in the Clinical Payment and Coding Policy for Evaluation and Management CPCP024
  • Prior Authorization Requests May Be Needed Due to Pharmacy Claims Processing Error
  • Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units
  • Prior Authorization Codes Updated for Commercial Members Effective Oct. 1
  • Prior Authorization Codes Updated for Medicare Advantage Effective Oct. 1

June 2024

  • Reminder: Provider Satisfaction Survey 2024
  • The Importance of Updating Provider Demographics
  • Pharmacy Program Quarterly Update Changes Effective July 1, 2024 — Part 1
  • ClaimsXtenTM Quarterly Update Effective Aug. 19, 2024
  • Behavioral Health Consultations During Hospitalization Can Improve Outcomes
  • Helping Our Members Manage Diabetes
  • Medical Records Reminder for Group Medicare Advantage (PPO) Members
  • Updated PEAQSM Methodology Is Now Available
  • Location requests now only accepted through the Demographic Change Form
  • Reminder: Use New Mailing Address for Paper Commercial Claims to Avoid Mail Delays
  • New: Access MCG Care Guidelines Clinical Criteria via Availity®
  • Update: Our Revised Clinical Payment and Coding Policy for Anesthesia Services now Effective Aug. 14, 2024

May 2024

  • Know the Importance of Care Coordination
  • Coding Webinars: Arrhythmias and Rheumatoid Arthritis
  • Supporting Maternal Quality Care
  • Electronic Claim Review and Ensuring the Correct Use of our Claim Review Form

April 2024

  • Webinar on Coding for Medicare Advantage Annual Wellness Visits
  • Prior Authorization code updates for Medicare Advantage
  • ClaimsXten™ Quarterly Update Effective June 17, 2024
  • Caring for Substance Use Disorders
  • Late and added charges must be submitted as a Corrected Claim
  • Filing Claims for Behavioral Health Services – Use the Correct Place of Service Code
  • Pharmacy Program Quarterly Update Changes Effective April 1, 2024 – Part 2
  • Prior Authorization Codes Updated for Commercial Members

March 2024

  • The Importance of Updating Provider Demographics
  • Medicare Advantage HEDIS Records Collection through June 2024
  • Federal Employee Program® Updates to Prior Approval Requirements and Benefits
  • Closing Gaps in Colon Care
  • Pharmacy Program Quarterly Update Changes Effective April 1, 2024 – Part 1
  • Follow-up Care for Mental Health
  • Avoiding the Inappropriate Use of Antipsychotic Medication in Anxiety Disorders
  • Reminder: Update Your Records with New Mailing Address for Paper Commercial Claims and Inquiries
  • Use the National Drug Codes Units Calculator Available in Availity® Essentials
  • See Our Revised Clinical Payment and Coding Policy for Anesthesia Services

February 2024

  • Blue Cross and Blue Shield Federal Employee Program® HEDIS® Records: Collecting February through April 2024
  • Managing Antidepressant Medication
  • Supporting Healthy Hearts
  • ClaimsXten™ Quarterly Update Effective April 15, 2024
  • Pharmacy Program Quarterly Update: Changes Effective Jan. 1, 2024 – Part 2
  • Coding Webinars: Major Depressive Disorder and Annual Wellness Visits
  • Changes to Claim Inquiry Resolution – High-Dollar, Pre-Pay Reviews Only

January 2024

  • Reminder: Update Your Records with New Mailing Address for Paper Commercial Claims and Inquiries
  • Update Your Records: New Medicare Open Access PPO Members and ID Cards
  • Prior Authorization Codes Updated for Commercial Members
  • Prior Authorization code updates for Medicare Advantage
  • Blue Cross and Blue Shield of Oklahoma began issuing direct payment to out-of-network providers, effective Nov. 1, 2023
  • Three New ClaimsXten™ Rules to be Implemented March 2024
  • Oral Oncology Pharmacy Network Transitioned to IntegratedRx™
  • Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2024 – Part 1
  • Monitoring Children Using ADHD Medication
  • Remind Our Members about Cervical and Breast Cancer Screenings
  • BCBSOK’s Approach to Managing GLP-1 Agonist Medications
  • Centers for Medicare and Medicaid Services Guidelines for Availability and Access Standards to Care for Medicare Advantage Members
  • Hospitals Must Provide Medicare Outpatient Observation Notice
  • Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed
  • Appropriate Use of Opioids Program to be Retired January 2024
  • Utilization Management: How to Avoid Delays and Denied Claims
  • Annual Medical Record Data Collection for HEDIS Quality Reporting begins Feb. 1

 

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