We appreciate those who were able to attend our one-hour Prior Authorization training. We hope that the webinar was helpful. We covered many topics; so if you have any outstanding questions, please reach out to Provider Relations at provider.relations@bcbswy.com or 1-888-666-5188.
We will provide helpful recaps of the webinar in the upcoming weeks. Stay tuned.
Coding Advice
M63 and Remittance
When a provider receives remark code M63 on the remittance advice, it means there is an invalid diagnosis code or the diagnosis code submitted on the claim is not permitted as the primary diagnosis code.
To correct this issue for reimbursement review, please submit a corrected claim and/or an adjustment form using the button below.
If you are submitting this form by mail, please send it to:
PO Box 2266
Cheyenne, WY 82003
Or by fax at (307) 432-2942
These appeals should not be submitted through Availity. If this is submitted through Availity, it will be closed in our Appeals Department and forwarded internally to our Claims Department for processing.
Please do not submit this form through Availity. If submitted through Availity this will show on your dashboard as cancelled.
Prior Authorization Update
Hearing Aids
Effective 01/01/2024, FEP will require Prior Authorization on Hearing Aids services.
Benefits for hearing aids and services associated with the preparation and fitting of hearing aids are only available when prior authorization is obtained before receiving the devices.
Failure to obtain prior authorization for services will result in a denial. Due to the FEP requirement, BCBSWY cannot accept appeals for these types of denials after 01/01/2024.
For more information on FEP’s Prior Authorization requirement for hearing aids, please see pages 53, 55-56 of the 2024 FEP Standard and Basic Option book, which can be found online here.
Additionally, routine hearing tests, hearing aids – including bone-anchored hearing aids, accessories, or supplies (including remote controls and warranty packages), and all associated services, and hearing aid exams are not covered.
For more guidance for FEP Blue Focus, please refer to page 49 here.
2024 FEP Standard and Basic Option Book
Prior Authorization Removed
Iron Sucrose and Ocular Angiogenesis Products
BCBSWY will be removing authorization requirements on Iron Sucrose (HCPCS Code J1756) and Ocular Angiogenesis products Eylea, Lucentis, Macugen, Visudyne (HCPCS Code J0178) as of 11/6/23.
Any pending prior authorizations for HCPCS codes J1756 or J0178 will receive an automatic approval regardless of date of service.
If you have any claims that deny for a date of service on or after 11/6/2023 for either of these codes, please contact our Provider Relations Department.
Any claims for date of service prior to 11/6/2023 may still deny as noncoverage, not medically necessary or no authorization. The standard retrospective authorization or appeals process will continue for those dates of service.
Please note that this change is effective for BCBSWY membership but does not include FEP.
Emergency Protocol Medication Authorizations
BCBSWY does not require prior authorization of emergency protocol medications. See drug examples below.
- HCPCS DESCRIPTION J1720 | INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
- J1200 | INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
- J1642 | INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
- J2175 | INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
- J2997 | INJECTION, ALTEPLASE RECOMBINANT, 1 MG
- J0171 | INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG
- J2469 | INJECTION, PALONOSETRON HCL, 25 MCG
- J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG