Important: While medical prior authorization submission requirements are changing October 1, 2026, the method of prior authorization requests for medications dispensed through a pharmacy are policy-dependent:
- BlueSelect (ID prefix: QWY, ZSK, ZSF)
- Submit to CoverMyMeds
- ID Prefixes:
- QWY: Small group off exchange
- ZSK: Individual on exchange
- ZSF: Individual off exchange
- BlueChoice & Wyoming Choice
- Drug-specific Forms available at www.myprime.com for faxing
- ID Prefixes:
- ZRW: BlueChoice
- ZYW: Wyoming Choice
- YWY: Wyoming Total Choice
For questions regarding pharmacy prior authorizations, please contact the Provider Relations team.
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.
NEW REQUIRED CATEGORY II CODES ON MEDICARE ADVANTAGE CLAIMS
Starting November 20, 2026, providers submitting claims for the following codes on a Medicare Advantage claim must be processed with a corresponding category II code or the claim will be denied:
- 80061 billed on a professional claim must have one of the following Category II codes on the claim: 3048F, 3049F or 3050F
- 83036 billed on a professional claim must have one of the following Category II codes on the claim: 3044F, 3045F, 3046F, 3051F or 3052F