Appeals and Peer to Peer Conversations
Providers may request appeals for Prior Authorization Requests and Concurrent Reviews which have been denied. The specific appeals process may vary from that outlined below depending on a Member’s specific benefit plan and state and/or federal regulations.
An appeal can be submitted by a member, provider or facility. Appeals can be submitted up to 180 days from the date of the denial notice from BCBSWY.
Appeals should be submitted in writing. BCBSWY does not require any specific forms to be utilized for submission.
Appeals should include the following components to help with timely determinations:
- A letter stating the denied services and the reason you feel the denial should be overturned, and
- The clinical documentation showing why the denied services should be considered medically necessary or should be considered on an individual basis.
Helpful Hint: Include claim numbers, authorization numbers and other member issue identifiers.
Once BCBSWY receives an appeal request, the appeal documentation is reviewed by medical review staff. Upon determination, BCBSWY will provide written notification to you and the member.
If you are unsatisfied with the determination of your appeal, please call Member Services at 1-800-442-2376 for further assistance.
Appeals should be sent to BCBSWY by mail or fax.
Blue Cross Blue Shield of Wyoming
PO Box 2266
Cheyenne, WY 82003-2266