At Blue Cross and Blue Shield of Oklahoma (BCBSOK), we are committed to providing support to physician practices. We've designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.
Authorizations & Referrals is an online tool in the Availity Provider Portal that allows you to submit preauthorization and/or referral requests handled by Blue Cross and Blue Shield of Oklahoma (BCBSOK). Learn More.
Availity's new online Claim Research Tool (CRT) provides your office staff greater claims accuracy and increased office efficiency in managing your account receivables. The CRT also ends the need for costly, time-consuming phone calls. Simply log into the Availity Website and follow the instructions on the CRT tip sheet . Use Availity's Claim Research Tool now .
It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.
To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information.
Availity Eligibility and Benefits Tip Sheets
- Eligibility and Benefits (General)
- Eligibility and Benefits – (General Expanded)
- Chiropractic Specialty
- Family Practice and Internal Medicine
- Obstetrics and Gynecology
- Physical Therapy
You must be registered with Availity to gain access to this and other online resources offered by Availity.
Availity is a registered trademark of Availity, L.L.C., an independent third party vendor that is solely responsible for its products and services.
Verification of eligibility and/or benefit information 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, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.
Social determinants of health are conditions in the environments where people live, learn and work that affect a wide range of health and quality-of-life outcomes and risks.
Blue Cross and Blue Shield of Oklahoma wants to help you identify patients that may need assistance with social factors that impact their health.
Please use this Social Determinants of Health Screening Tool to determine if your patient may need additional assistance.
For more information and additional resources visit 211.org .
The AvailityTM Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from BCBSOK. Beginning Feb. 15, 2018,providers can upload and submit the necessary medical records to BCBSOK using the Medical Attachment option in the Claims & Payments menu through the Availity Web portal. Learn More.
Behavioral health professionals and physicians may obtain benefits information for Blue Cross and Blue Shield members using the Availity® Eligibility and Benefits (E&B) tool. This free online tool can provide you with copayment, coinsurance, deductible, and other important information. Learn More.
BCBSOK, in partnership with the Blue Cross and Blue Shield Association, has developed Blue Distinction Centers. Each Center has been selected through a rigorous, evidence-based, objective selection criteria established with input from medical experts and organizations.
Blue Distinction is a nationwide program that will create an unprecedented level of healthcare transparency with two goals: engaging consumers to enable more informed healthcare decisions and collaborating with providers to improve quality outcomes and affordability.
To learn more about the program, selection criteria, and designated centers in each state, visit Blue Distinction for ProviderSM.
BCBSOK is licensed as a sponsor of the Bridges to Excellence® (BTE) Diabetic Care Recognition program and Cardiac Care Recognition programs. Learn More.
The Availity® Patient Cost Estimator (PCE)tool provides real-time estimation of member responsibility. This feature can be utilized at the time of service, enabling professional providers to collect copayments, coinsurance and deductible amounts up front for BCBSOK members. Learn more.
The Claim Inquiry Resolution tool can be accessed via a tab in our Electronic Refund Management (eRM) system. The CIR tool allows you to communicate online with our Customer Advocates in some situations where previously a call or letter was required. Learn more.
The Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSOK for the following members:
- Blue Cross Medicare Advantage HMOSM
- Blue Cross Medicare Advantage PPOSM
Clear Claim Connection is a Web-based code auditing reference tool that mirrors BCBSOK edits (i.e., unbundling, mutually exclusive, and incidental). Learn more.
Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSOK members using CQV. Learn more.
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Oklahoma (BCBSOK) pharmacy PA program. Learn more.
This online refund management tool will help simplify overpayment reconciliation, as well as related processes and transactions. Use the ERM tool now.
Our automated preauthorization tool – iExchange – supports direct submission of referrals and provides online approval benefits for inpatient admissions, as well as select outpatient, pharmacy and behavioral health services 24 hours a day, seven days a week – with the exception of every third Sunday of the month when the system will be unavailable from 11 a.m. to 3 p.m. (CT). iExchange is accessible to physicians, professional providers and facilities contracted with BCBSOK. Learn more.
Patient Care Summary is a user-friendly, electronic health record that assists health care professionals in making informed treatment decisions for their patients. It's available free of charge to physicians and provider organizations registered with Availity in Oklahoma. To register, visit availity.com , or call Availity Client Services at (800) AVAILITY (282-4548). Learn more about Patient Care Summary.
The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSOK in the 835 Electronic Remittance Advice (ERA). Learn More.
The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Learn More.