Prior Authorization Service Request
A Prior Authorization Service Request is the process of notifying BCBSWY of information about a medical service 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.
How to Determine if Prior Authorization is Required
You can verify coverage, benefits and determine procedure prior authorization requests by going to Availity.com.
Complete a Prior Authorization Request
For services which require BCBSWY prior authorization, login to Availity. The Authorization Tool is found under Patient Registration.
You can also complete a 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. These 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.
*For further explanation of the urgent prospective review criteria, please visit the
U. S. Department of Labor
You can use the Availity authorization dashboard to see the status of all authorizations in your organization.