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 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
- ZSD
- ZSF
- ZSH
- ZSK
- ZSM
- ZSP
- ZYW
- R (FEP)
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.
Complete a Prior Authorization Admission Request:
A provider should submit an admission request to 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 submit a request to 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 Get Started
- Log in to Availity. The Authorization Tool is found under Patient Registration. Complete the prior authorization service request (if required) AND admission request.
- You should only call 307-829-3081 to request the following admissions: Skilled Nursing Facilities, In-Patient Hospice Care, Acute Rehabilitation Facilities, Transitional Care Units, Swing bed admissions, Residential Treatment Facilities. Be prepared to include the following information:
- 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
Concurrent Review
Once a patient has exhausted their initial authorized length of stay, you can request an extension through the Availity portal, if the request was initiated using Availity. BCBSWY requires notification of discharge date.
First, go to Authorization Dashboard and find the Inpatient authorization that requires an extension. Then, select Update. Follow the prompts to complete the request. See this step by step guide to see how to request additional inpatient days through Availity.
Providers can also 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, (307) 432-2756, 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.
Newborn Admission Request
Admission requests are not required per the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) unless the newborn is admitted for more than 48 hours or 96 hours in the case of cesarean delivery.
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.
Checking Status
You can use the Availity authorization dashboard to see the status of all authorizations in your organization.
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 be sent here? |
| Authorizations | 307-432-2917 |
|
| Concurrent Review | 307-432-2756 | Updates and records for current inpatient hospital stay |