As a contracted provider, please be advised that effective January 1, 2026, all claims submitted to WyoBlue Advantage must include a valid taxonomy code. Claims submitted without a valid taxonomy code will be automatically rejected and returned for correction.
This requirement applies to all claims, including those with a rendering provider.
We appreciate your continued partnership and commitment to compliance. Please reference the implementation details below:
- Taxonomy codes ensure accurate routing of claims based on provider specialty and practice type.
- Taxonomy information is required by payer-to-payer and government standards.
- Properly coded claims reduce manual edits and support faster adjudication and payment.
Frequently Asked Questions
Q: What if a provider has multiple specialties?
A: Use the taxonomy that best reflects the service rendered on the specific claim. If multiple specialties apply, select the taxonomy for the primary service.
Q: Is there a grace period after January 1, 2026?
A: No. Claims received without a taxonomy code after this date will be rejected automatically.
Please ensure your systems and billing processes are updated accordingly in advance of the go-live date.
CHANGES TO APPEAL SUBMISSIONS
NOW EFFECTIVE
On January 1, 2026 we made important updates to how appeals are handled. These changes are designed to reduce delays and ensure your requests are processed efficiently.
Streamlining Appeals: What You Need to Know
We’ve seen a rise in requests labeled as “appeals” that do not meet the criteria. These misrouted submissions—such as those needing corrected claims, additional documentation, or coordination of benefits (COB) updates—are automatically stopped at intake and cannot proceed to review.
What Qualifies as an Appeal?
An appeal is a formal request to reconsider a processed claim due to disagreement with the payment determination.
What Does Not Qualify as an Appeal?
Please do not submit an appeal for:
- Corrected claims (e.g., billing or provider changes, member info updates, duplicate corrections)
- Missing or additional documentation needed for claim processing
- COB-related denials that require member action
- Denials that state “no appeal rights exist”
Submitting these as appeals will result in immediate return without review, delaying resolution.
Though the above services may be submitted as a reconsideration request; a formal appeal is generally reserved for denials based on Not a Benefit, Investigational, or Not Medically Necessary determinations.
What to Do Instead
To ensure timely processing:
- Submit a corrected claim for updates to claim data
- Provide requested documentation when indicated in the denial
- Ask the member to update their COB with the plan
- Review your remittance advice and follow the ANSI code instructions
By routing your requests appropriately from the start, you help us process them faster and more accurately.
An urgent appeal request is considered urgent only when, in the opinion of a physician familiar with the member’s condition, using the standard (non-expedited) timeframe could:
- Seriously jeopardize the member’s life, health, or ability to regain maximum function; or
- Subject the member to severe pain that cannot be adequately managed without the requested care or treatment.
If you’re unsure whether a situation qualifies as an appeal, please reach out to Provider Relations for assistance.
ENSURING TIMELY, COMPLIANT REVIEW OF URGENT PRIOR AUTHORIZATION REQUESTS
To support our commitment to timely and compliant prior authorization reviews, Blue Cross Blue Shield of Wyoming encourages providers to review the statutory definition of an urgent prior authorization under Wyoming Statute §26-55-102. Accurate submissions help ensure members receive the care they need without unnecessary delays.
What Qualifies as Urgent?
A prior authorization request is considered urgent only when, in the opinion of a physician familiar with the member’s condition, using the standard (non-expedited) timeframe could:
- Seriously jeopardize the member’s life, health, or ability to regain maximum function; or
- Subject the member to severe pain that cannot be adequately managed without the requested care or treatment.
Note: Urgent health care services include mental and behavioral health services.
Submitting an Urgent Request
To help avoid processing delays, please ensure:
- Clinical documentation clearly supports why the standard timeframe would jeopardize the member’s health or cause unmanaged pain.
- The urgent designation is based on the judgment of a physician knowledgeable about the member’s condition.
- Requests that do not meet the statutory definition will be reviewed under standard timeframes.