Reminders and Helpful Tips – May 2, 2019

We’re continuing to get claims through the system as quickly as we can and have added additional staff to work on these priority claims.

Some common errors that can delay processing times for claims and authorizations are included below. Please take a few minutes to review this information.

Taxonomy Codes

Our new system now requires you to include your taxonomy code on professional claims. The taxonomy code should populate in box 24j, please be sure to include indicator “ZZ” in box 24i. If you’re unsure of your code give us a call and we can assist.

Prior Authorization

Inpatient hospital stays require prior authorization irrespective of the prior authorization for the procedure. Hospitals and surgeons need to coordinate submission of prior authorization requests for procedures requiring an inpatient hospital stay.

NCCI

Please remember that we are now compliant with National Correct Coding Initiative (NCCI). If you have seen an increase in claims returned to you for corrections, it may be a result of CCI edits. Many claims now need a specific modifier in order to pay. There are many public resources available to guide NCCI coding.

How to fix the Eligibility and Claims Status Error – “Provider Not Found”

If you have received an error “provider not found” when making an inquiry, verify the NPI you’re using. The correct NPI to use is the Organization’s Billing NPI. Using the Physician’s (rendering) NPI will cause this error to occur.

Prefix Reminder:

As a reminder, new member ID numbers will have a 3-character prefix followed by 12 digits. For your information, here are the new ID prefixes.

Network

Product Type

ID Card Prefix

BlueSelect PPO ZSK
FEP PPO R
Kid Care CHIP PPO ZSC
Medicare MedSup ZSM
Wyoming Select PPO ZSF
Wyoming Select PPO QWY (previously ZSH)
Wyoming Total Choice PPO YWY (previously ZSP)
Participating Provider Trad ZSD
Participating Provider Trad ZRW (previously ZSA)
Participating Provider Indem ZRW (previously ZSA)
Participating Provider PPO ZRW (previously ZSA)
Wyoming Choice PPO ZYW (previously ZSP)

Fax Numbers

For faster service, please send requests/documents to the correct fax number below.

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

Call Center Hours

Please remember our call center is now open from 7:00-8:00 a.m. exclusively for provider calls. Call 888-359-6592 to take advantage of this option for reduced on-hold time.

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