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Prior Authorization Admission Request

A Prior Authorization Admission request is the process of notifying Blue Cross Blue Shield of Wyoming (BCBSWY) of an inpatient stay. The participating Provider or Member must notify BCBSWY of ALL inpatient stays including maternity and emergency admissions. When a patient is transferred from one facility to another, the Provider of the receiving facility should notify BCBSWY.

Our policies begin with the following prefixes: QWY, YWY, ZRW, ZSC, ZSD, ZSF, ZSH, ZSK, ZSM, ZYW, and R.

For all other prefixes, please call 1-800-676-2583 to find the Blue Cross Blue Shield Plan you will need to contact for Prior Authorization Admission requests.

When to Call BCBSWY:

A provider should call BCBSWY when:

  • A patient is being scheduled for an inpatient stay
  • A patient is being admitted for an inpatient stay
  • A patient is a FEP member and is in an observation status greater than 48 hours

A provider does not need to call BCBSWY when:

  • A patient is a FEP member and is in an observation status less than 48 hours
  • A patient is on Medicare and has a contract number beginning with ZSM
To complete the Admission Review:
  • Call 1-800-251-1814
  • You will be prompted to leave a voice mail. Please include the following information in your voicemail:
    • Name of caller, caller’s facility, and caller’s phone number
    • Name of patient, patient’s date of birth, patient’s policy number
    • Date of admission
    • Admitting diagnosis including diagnosis codes
    • Admitting procedure including CPT codes
    • Physician’s name including spelling, physician’s address and fax number
    • Facility name, facility address and fax number
    • Type of stay – Outpatient, Observation, or Inpatient

Once the information is received and processed, we will notify you of an authorization number and an initially authorized length of stay. Prior Authorization may be required for services being performed.

Concurrent Review:

Once a patient has exhausted their initial authorized length of stay, the provider should call 800-251-1814 or fax a request to the Concurrent review fax number at (307) 432-2756 requesting an extension. BCBSWY requires notification of discharge date and you can fax this to the concurrent review fax number or call 800-251-1814.

Special Circumstances:

Transplants:
For questions about transplants or authorizations call our transplant coordinator 307-829-3081.

Residential Treatment Facility:
For questions about residential treatment facility (RTF) authorizations call
307-829-3081.

FEP Prior Authorization:
For authorizations of the following services, please contact FEP case management at 1- 800-210-7257.

  • Applied Behavioral Analysis
  • Gender Reassignment
  • * Residential Treatment Facility
  • * Skilled Nursing Facility/Center

* FEP does not permit retroactive authorizations.

Contact Us:

Providers: Call Utilization Review staff at 800-251-1814 with questions, concerns, or to complete an update.

Members: Call Member Services at 800-442-2376

Document Destination Fax Number What should get sent here?
Authorizations 307-432-2917
  • Prior Authorization requests
  • Pre-admission inpatient hospital authorization
  • Pharmacy authorizations
Concurrent Review 307-432-2756 Updates and records for current inpatient hospital stay

 

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