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Prior Authorization Service Request

Prior Authorization requests for services is the exchange of information between Providers and BCBSWY to establish medical appropriateness and necessity of services.

Members of some health plans may have terms of coverage or benefits that differ from the information presented here. The following information describes the general policies of Blue Cross Blue Shield of Wyoming and is provided for reference only. This information is NOT to be relied upon as pre-admission or prior authorization request for health care services and is NOT A GUARANTEE OF PAYMENT.

Determine if a Prior Authorization Request is Required:

You can verify coverage or benefits or determine pre-admission or prior authorization request requirements for a Member by calling 1-800-442-2376.

Benefits will be denied if the patient is not eligible for coverage under the benefit plan on the date services are provided or if services received are not medically appropriate and necessary. Inclusion of a service on this guideline does not guarantee payment.

Complete a Prior Authorization Request:

For services which require BCBSWY prior authorization, complete the
Prior Authorization Request Form and submit it as instructed. Medical records will be required with each submission.

Please only mark a prior authorization request URGENT* if failure to receive treatment will result in a life or limb threatening situation. Non-urgent requests marked urgent will delay processing. BCBSWY does not recognize scheduling conflicts as an urgent request.

**Processing a Prior Authorization Request:

When BCBSWY receives a prior authorization request from a Provider, it will be reviewed by our clinical staff. BCBSWY’s Medical Policies are used in this review.┬áThese policies are available online for providers and are searchable by title, CPT code and identification number.

**A determination (approved or denied) will be rendered from the information submitted:

  • Non-urgent prior authorization requests will be processed within 14 calendar days from date of receipt.
  • Urgent* prior authorization requests will be processed within 3 calendar days from date of receipt.
  • The Provider, rendering facility and member will be notified in writing of the determination (via U. S. Mail).
  • Once a determination has been made a fax response will be immediately sent.
Contact Us:

The provider or member is encouraged to contact BCBSWY Member Services at
800-442-2376 if a determination has not been received within the timeframes shown above.

*For further explanation of the urgent prospective review criteria, please visit the
U. S. Department of Labor.

 

 

 

 

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