We are excited to share that our AGM platform has officially gone live. As with any major system transition, we continue to monitor performance closely to ensure a smooth experience for our provider community.
During this process, we identified an issue affecting appeals submitted through Availity. At this time, comments entered by providers within Availity are not being transmitted to us, which means our teams cannot view the information you include in the comment field. Many providers use this field to explain the reason for appeal, and without that information, we are unable to determine the intent of the request.
What Providers Need to Do
Until this issue is resolved, all appeals submitted through Availity must include a cover sheet that clearly outlines:
- The reason for the appeal
- Any supporting details typically entered in the Availity comment field
- Any additional documentation needed for review
Appeals submitted without a cover sheet may experience delays or may need to be returned if we cannot determine what is being appealed.
Why This Matters
We know your time is valuable, and we want to avoid unnecessary back‑and‑forth or processing delays. Using a cover sheet ensures we have the information needed to review your appeal promptly and accurately.
Claim Edit Enhancements Effective June 1, 2026
Updates to several claim edits (DPs) will now take effect June 1 to align with CMS guidance and current clinical recommendations. This is an update to the initial effective date of July 1, 2026.
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.
Questions? Contact us for assistance:
BCBSWY:
📞Call the Provider Relations at:
1-888-666-5188
📧 Email Provider Relations at:
[email protected]
🌐Visit us online at:
www.bcbswy.com