Updates to several claim edits (DPs) will take effect July 1 to align with CMS guidance and current clinical recommendations.
Gastrointestinal Pathogen Panels
- Non‑Covered GI Panels (DP 19446)
Large gastrointestinal pathogen panels—such as those billed with codes similar to 85707—are considered non‑covered under all clinical scenarios based on guidance from IDSA, ACG, and current medical literature. - Repeat Testing Limits (DP 17773)
GI pathogen panel codes (87505, 87506, 87507, 0369U) should not be repeated within seven days for the same episode of diarrhea, regardless of provider.
Respiratory Pathogen Panels
- Non‑Covered Multiplex Respiratory Panels (DP 14717)
Multiplex PCR respiratory viral panels testing for five or more pathogens do not meet Medicare’s “reasonable and necessary” criteria. These panels include pathogens that are rarely indicated and do not reflect specific syndromes or seasonal patterns. Claims billed with codes such as 87632, 87633, 0115U, 0202U, 0223U, 0225U, 0373U, 0563U, and 0564U will deny.
BCBSWY President & CEO Diane Gore Announces RetirementWe begin with a sincere appreciation for Wyoming’s provider community. Your partnership ensures strong coverage and high-quality care for the members and communities we serve together. Blue Cross Blue Shield of Wyoming is sharing news of an important leadership transition. President and CEO Diane Gore has announced her retirement and Executive Vice President, Kris Urbanek will succeed her effective May 1, 2026. Kris has built his career working alongside providers and understands the realities of delivering care — especially in rural communities. He has deep respect for the role providers play in the health of Wyoming families, and I know his leadership will reflect his commitment to strong, collaborate provider partnerships across our state.” — Diane Gore We remain committed to working closely with you to support accessible, sustainable, high-quality care for Wyoming. |
A New Digital Member Experience is On the WayBCBSWY continues to invest in tools that help members navigate their health care with greater ease. As consumer expectations evove, we’re expanding digital capabilities that make it simpler to find information, communicate, and state connected. This month, we’ll unveil enhanced digital member features — including a new mobile app — designed to offer more convenient, personalized ways for members to manage their coverage and engage with their health plan.
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Register Now for the WyoBlue Advantage Provider Webinar on March 25With Open Enrollment for 2026 now complete, WyoBlue Advantage is officially underway — and thousands of Wyoming residents are already putting their health care plan benefits to use. As more Wyoming residents begin using their new WyoBlue Advantage benefits, we want to ensure providers have the information and support they need. Join the BCBSWY Provider Relations team on March 25 for an informational webinar covering both WyoBlue Advantage and its partner program, Arkos Health, and get your questions answered. WEBINAR DETAILS
HOW TO REGISTERYou can register for the webinar by visiting our Provider page at BCBSWY.com/providers or by clicking below: |
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