Blue Cross Blue Shield of Wyoming (BCBSWY) is committed to providing our Provider community with updates and best practices to improve the processes required to submit prior authorizations for your patients.
We understand that the prior authorization process can be confusing. Here are some important updates to know about:
New Medical Policies: BCBSWY has recently updated posted medical policy updates effective 2/1/25. Click here to view these updates.
Drug prior authorization requests: Recent changes in the process for drug prior authorization requests have occurred due to updates with one of our vendors.
Review the following steps clarify the procedures for submitting a pharmacy prior authorization. Please note that step two is a temporary workaround while we review potential solutions. We hope this helps reduce some of the confusion caused by the recent changes.
Submitting a Pharmacy prior authorization:
1: For Members with Prefixes ZSF, QWY, or ZSK:
- Submit the request through covermymeds®.
2: For Members with IDs Starting with ZRW, ZSD, ZWY, or YWY:
- Complete the correct pharmacy prior authorization form from MyPrime and save it as a PDF.
- Fill out the Availity request with the following key points:
- Do not use the covermymeds link. Use “Authorization Request.”
- The request type is “Outpatient” Authorization.
- If the drug doesn’t have its own HCPCS code, use “J3490 – Unclassified Drugs” for the procedure code.
- Complete provider details.
- Upload the saved drug-specific form under “Recent attachments.”
- Complete the rest of the Availity form.
If you would like additional information, please click on the button below. This is a step-by-step guide for submitting BCBSWY pharmacy prior authorizations through Availilty.
FEP PRIOR AUTHORIZATIONS
We are aware that FEP in-patient authorization letters are being sent without member information. To view FEP authorization status login to the Availity provider portal and use the Authorization Dashboard to find the status.
A solution has been identified, and work is in progress to correct this technical issue.
IMPORTANT DATES
Upcoming Business Hours & Closures
Tuesday, Dec. 24: Closing at noon
Wednesday, Dec. 25: Closed
Tuesday, Dec. 31: Closing at 3:00 p.m.
Wednesday, Jan. 1: Closed
Preventive Visits Webinar – January 16, 2025
This webinar is geared toward primary care and family practices. BCBSWY will review coding requirements, including proper CPT codes and diagnosis codes to ensure correct billing practices. This, in addition to proper coding for sick visits when combined with annual wellness visits and the reimbursement policy.
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
No Surprises Act (NSA) requires you confirm this information every 90 days.