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Frequently Asked Questions for Medical Providers

Updated September 21, 2018

Why is BCBSWY making this transition?

In order to better serve our members, employer groups, providers and other key stakeholders, Blue Cross Blue Shield of Wyoming made the decision to update our internal IT and operating systems to offer increased efficiency, making it easier and quicker to work with us.

Local ownership has always been important to us, and our new partnership allows us to gain the updated capabilities of a 10 million-member health plan while remaining an independent, not-for-profit, Wyoming-based business.

Availity has been selected as the preferred method for providers to manage claims and remittances, and complete other secure administrative tasks online. Availity is a multi-payer site where you can register with a single user ID and password to work with BCBSWY and other health plans online.

Availity is compliant with all HIPAA regulations, and there is no cost for providers to register or use any of the online tools.

How can I make sure I stay informed?

BCBSWY regularly sends e-bulletins, if you’re not receiving them email provider.relations@bcbswy.com and request to get added.

Electronic Remittance Advice (ERA)

How do I start receiving my electronic remittance advice (ERA)?

Register and login to Availity

Click My Providers | Enrollments Center | ERA Enrollments

Set up ERA reporting preferences


Click Claims & Payments | EDI Reporting Preferences and then the Claim Payment/Advice tab

Then follow the prompts and click submit. After submitting, you’ll be notified by email that enrollment is complete and you’ll start receiving 835 ERAs from Availity.

If a provider is enrolled in ERAs but the Medicare crossover claims drop to paper today, will that history be in Availity like they are under the non-local button in THOR?

Historical ERAs that have been sent via paper will not be available in Availity. However, moving forward, crossover claims that process on the new platform will generate an ERA and will be viewable in Availity.

Are historical remits loaded to Availity?

Six months of ERAs have been loaded to Availity for providers who have historically had access to electronic remits. If you aren’t working with a clearinghouse and you want to start receiving ERAs, you will need to complete the ERA enrollment process with Availity.

In the new system, will professional and institutional remits be delivered together or separately?

Professional and institutional remits will be delivered separately (as they are today).

Can I view electronic remits for out of state BCBS members in Availity?

Yes, out-of-state BCBS claims are part of your BCBSWY ERA and should be available through the Availity Provider Portal. If you are not able to access remits, you should contact Availity Client Services at 1-800-AVAILITY.

New! Medical Policies

Are medical policies changing?

Medical policies have been updated and new ones have been added in an easy-to-search format. These updated policies will offer clarification to authorization requests or claims denials and can be viewed at BCBSWY.com/providers/policy/.

New! Pre-Authorization Request

Are pre-authorization requests changing?

Pre-authorization guidelines have been updated and are available at: BCBSWY.com/precert/. Please review carefully and make note of the new Authorization Request form and fax number 307-432-2917 to submit authorization requests.

How long can I expect a prior authorization request to take?

As we transition to a new utilization management system, you may experience a longer than usual wait time for prior authorization approvals including preadmission reviews. Eventually, electronic submission of prior authorization requests can be done through the Availity portal with an automated review that will reduce turn-around time.

Starting in October, your office will receive an automatic fax response when a determination is made, followed by mail confirmation.
New! Fax Numbers Are Changing

Are there other important fax numbers I should know?

As we transition to a fully automated fax system, please note the correct fax number below for authorization requests, records, and appeals. Beginning in February 2019, these fax lines will be completely automated and documents sent to incorrect fax numbers will be delayed.

Please note, we have experienced technical difficulty in receiving faxes over 75 pages, which also creates issues for faxes sent following large fax files. If you are faxing a file over 75 pages, please reach out to BCBSWY Provider Relations at 888-666-5188 to discuss your options.

Document Destination

Fax
Number

What should get sent here?

Authorizations

307-432-2917

  • Pre-authorization request
  • Initial inpatient hospital authorization
  • Pharmacy authorizations

Concurrent Review

307-432-2756

  • Updates and records for current inpatient hospital stay

Appeals

307-432-2942

  • All pre and post service appeals
  • Claim Adjustment forms and records

Medical Records

307-635-9366

  • Requested medical records
  • Records for denied claims and authorizations

 

What is the timeline?

We expect the project to be complete in 2019. BlueCard® (members with other BCBS coverage) transitioned July 1, 2018. A small number of BCBSWY members transitioned to the new system on September 1, 2018, with most transitioning January 1, 2019.

How do I know if a member has transitioned to a new system?

The ID card will be your indicator for coverage. Member ID cards will continue to be issued by BCBSWY. Those who are transitioning September 1, 2018 will have the prefix QWY, ZRW, or ZYW.

What will the new member ID cards look like?

ID cards will look very similar to the cards our members have today. As members move to the new system, they will receive new ID cards with a new ID number. A helpful differentiation is the number of digits in a member ID number, which is changing from 9 to 13 digits.

How will claims be processed during the transition?

During the transition period, which occurs from July 2018 through January 2019, we will route claims internally to the appropriate system (legacy systems or HMHS) based on the date of service.

When will providers transition to the Availity Provider Portal?

The Availity Provider Portal became available in April 2018 and is now our preferred method for providers to work electronically with us.

When will providers transition to the new Availity EDI service?

Availity EDI, also referred to as Availity Intelligent Gateway, is now available. All providers should be transitioned to Availity for EDI services. If you’re unsure of your status contact Availity at 800-282-4548 or check with your clearinghouse or billing software company.

Does Availity have a customer service team? If so, how do I know who to call for help?

Yes, Availity has a dedicated customer service team. If you have questions surrounding the Provider Portal or the Availity Intelligent Gateway system, such as login issues, how to navigate the portal, or other technical questions, you should contact Availity directly. Questions regarding claims, member eligibility and how to work with our health plan should be directed to BCBSWY Provider Relations. You can email provider relations here.

What are the differences between THOR and Availity?

Availity offers similar core functionality of THOR but in an easier-to-navigate format. Providers will be able to submit eligibility and benefits inquiries, submit claims, review claim statuses and view electronic remittances. The Availity Portal has an enhanced user experience with a different look and feel. Training on how to use the new portal is strongly encouraged for all new users and can be found on the Availity Portal.  

Will BCBSWY continue to support PC-ACE submissions?

BCBSWY has decided to discontinue support of the PC-ACE software click here for more information.

Will we receive training on the new systems?

Yes, we will continue to partner with Availity to offer training and on-demand webinars to make sure you are comfortable with the new process.

It can take some time for the organization’s administrator to set up users with Availity. Is there a quicker way to set up users?

Availity has the ability for the administrator to upload a list of users for easier registration.

When will the eligibility and benefits tool be available in Availity for BCBSWY members?

We’re in the process of verifying all eligibility and benefits information transitioned to the Availity system correctly. We hope to have this feature available soon and we will let you know when. THOR will continue to be available to verify eligibility and benefits.

Is THOR going away?

Eventually, the provider applications used in THOR will no longer be needed and your access will be disabled.

How will we receive updates about this process?

We will regularly update this site and will also send email communications.

 

Further, United Concordia, Davis Vision, Dearborn National, Lifetime Benefit Solutions and
HM Health Solutions are independent companies providing administrative services for
Blue Cross Blue Shield of Wyoming clients and members.

Questions about
BCBSWY Business Transformation?

Send us an email