Download and print commonly used forms. All forms are in PDF format. Download Acrobat Reader.
- Advance Member Notice Waiver Form
- Use this form to advise a patient that the requested service is a non-covered benefit with BCBSWY.
- Direct Deposit Payment
- Submit this form to authorize claims payment via direct deposit to your bank account. Read guidelines
- Institutional Claim Adjustment
- Use this form to file an adjustment to an institutional claim. Instructions
- Insurance Questionnaire
- This form is used to verify the healthcare coverage of your patients and to assist you in determining primary and secondary coverage. Read guidelines
- Prospective Request (Pre-certification)
- This form may be used by a healthcare provider to notify BCBSWY of a patient's intent to receive services requiring prior certification.
- Professional Claim Adjustment
- Use this form to file an adjustment to a professional claim. Instructions
- Specialty Prescription Referral
- A healthcare provider may submit this form to enroll a patient in the Specialty Medication program.
- Synagis® Statement of Medical Necessity for RSV
- Use this form for BCBSWY authorization of Synagis for the treatment of Respiratory Syncytial Virus (RSV).
We're here to help.
Monday-Friday 8 a.m. - 5 p.m.
Search our network of healthcare providers.
Drug list, cost estimator and more.
View BCBSWY guidelines for coverage.
Propose inpatient stay and request specified services.
Find Medical Policy and Precertification/Preauthorization outside Wyoming