Provider Tools

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.

Availity^® Authorizations & Referrals

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^® Attachments: Submit Predetermination of Benefits Requests Online

Attachments is an online tool in the Availity Provider Portal that allows you to submit electronic predetermination of benefits requests handled by Blue Cross Blue Shield of Oklahoma (BCBSOK). Learn More

Availity Eligibility and Benefits

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.

For additional details refer to the Availity Eligibility and Benefits User Guide .

You must be registered with Availity to gain access to this and other online resources offered by Availity.

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. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

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 Screening Tool

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 .

Responding to Quality and Risk Adjustment Medical Record Requests Online via Availity^TM Web Portal

The Availity^TM 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.

Blue Distinction^®

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 Provider^SM.

Bridges to Excellence

BCBSOK is licensed as a sponsor of the Bridges to Excellence^® (BTE) Diabetic Care Recognition program and Cardiac Care Recognition programs. Learn More.

Patient Cost Estimator

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.

Claim Inquiry Resolution (CIR) Tool

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.

Claim Status Tool

The Availity^® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSOK.

Learn more

Clear Claim Connection

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) Application

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^®

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.

Electronic Claim Submission via Availity^® Provider Portal

Availity’s Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to Blue Cross and Blue Shield of Oklahoma (BCBSOK), at no cost. Learn More.

Electronic Clinical Claim Appeal Requests via Availity^®

The Dispute tool allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity Portal. Learn More.

Electronic Refund Management (ERM)

This online refund management tool will help simplify overpayment reconciliation, as well as related processes and transactions. Use the ERM tool now.

Fee Schedules via Availity^® (Professional Providers)

The Availity Fee Schedule viewer tool allows professional providers participating with BCBSOK to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform.Learn More.

National Drug Code (NDC) Units Calculator Tool via Availity^®

The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT^®) codes to NDC units. Learn More.

Patient Care Summary^®

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.