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Upcoming Changes to the Provider Claim Review Form

December 1, 2016

Effective January 1, 2017, the paper Provider Claim Review Form for Blue Cross Blue Shield Oklahoma (BCBSOK) will be simplified for providers when submitting written claim inquiries.

The most efficient way to request a claim review for specific inquiries is electronically through Availity™ Learn more about third-party links using the Claim Inquiry Resolution (CIR) tool. When you must submit a claim review via paper, it is submitted using one universal Claim Review Form. As a result, this form is utilized for several different reasons; such as, paper corrected claims, requested medical records, claim check denials, or even basic claim reviews.

BCBSOK is streamlining the paper claim review process which will allow more accurate processing. As of Jan. 1, 2017, written claim inquiries must be submitted on one of the specific provider Claim Review Forms listed below. Each Claim Review Form must include the BCBSOK claim number (Document Control Number), along with the key data elements specified on the forms.

New Provider Claim Review Forms:

  • Additional Information Form
  • Claim Review Form
  • Corrected Claim Form

Verification of online claim status is strongly encouraged prior to submitting claim reviews. The most effective way to determine claim status is electronically through your preferred web vendor; such as Availity Claim Research Tool. Making use of electronic options allows retrieval of needed information in real-time.

As indicated above, Availity users have access to the Claim Inquiry Resolution tool, which delivers a method of online assistance for specific inquiries on finalized claims. This tool is designed to help save you time by reducing the amount of calls and written inquiries submitted.

To learn more about these online options, view the Provider Tools section in our Education and Reference Center at bcbsok.com/provider. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbsok.com

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.