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Frequently Asked Questions for Medical Providers

How can I make sure I stay informed?

BCBSWY regularly sends e-bulletins, if you’re not receiving these email provider.relations@bcbswy.com and request to get added.
You can find past e-bulletins here.


Availity Provider Portal

Can providers work electronically with BCBSWY?

The Availity Provider Portal is our preferred method for providers to work electronically with us. All providers should be using Availity for EDI services. If you’re unsure of your status contact Availity at 800-282-4548 or check with your clearinghouse or billing software company.

Does Availity have a customer service team? If so, how do I know who to call for help?

Yes, Availity has a dedicated customer service team. If you have questions surrounding the Provider Portal or the Availity Intelligent Gateway system, such as login issues, how to navigate the portal, or other technical questions, you should contact Availity directly. Questions regarding claims, member eligibility and how to work with our health plan should be directed to our BCBSWY Provider Support team, you can reach a representative by calling 888-359-6592.

What are the differences between THOR and Availity?

Availity offers similar core functionality of THOR but in an easier-to-navigate format. Providers can submit eligibility and benefits inquiries, submit claims, review claim statuses and view electronic remittances. The Availity Portal has an enhanced user experience with a different look and feel. Training on how to use the new portal is strongly encouraged for all new users and can be found on the Availity Portal. 

How do we receive training on Availity?

The Availity Learning Center has a selection of topic-based webinars ranging from
3-30 minutes.

The Availity Portal Onboarding – Training Program includes:

  • Brief video tour
  • Checklists for new users and Admins (including a downloadable PDF for Admins)
  • Tips, timesavers, etc.
  • Instructions to use Self-Service and Support
  • A link to the new Plot Your Learning Path feature in the ALC Forum

You can also view the BCBSWY Provider webinar for tools and tips on using Availity. Here is how to find it:

  • Login to Availity
  • Select Help & Training I Get Trained
  • The Availity Learning Center will open a new web browser tab
  • In the catalog, search by keyword “Wyoming”
  • Enroll for the course – Introduction to Availity for BCBSWY Providers On-Demand

It can take some time for the organization’s administrator to set up users with Availity. Is there a quicker way to set up users?

Availity has the ability for the administrator to upload a list of users for easier registration.

Is THOR going away?

Access to the provider applications in THOR will not be available after 2/4/2019. Only providers who had access to THOR prior to 12/31/18 are able to continue accessing THOR; we are not able to grant access to new users.

How do I know if a member has the correct member ID card?

Member ID cards are issued by BCBSWY.  A helpful differentiation is the number of digits in a member ID number, which has changed from 9 to 13 digits.

Do providers have the capability to make a claim adjustment in the Availity Provider Portal?

Currently, the process for adjusting a claim is done using a claim adjustment form. We’re looking into an electronic process to complete adjustments in Availity, and we will let you know when this capability is available.

Does BCBSWY support PC-ACE submissions?

BCBSWY does not support PC-ACE software click here for more information.

How do I check eligibility and benefits for BCBSWY members?

Eligibility and benefits inquiries may be completed online easily and efficiently using the Availity Eligibility and Benefits tool. To get started:

  1. Click Patient Registration I Eligibility and Benefits Inquiry
  2. Select BCBSWY from the Payer drop-down for local policies
  3. Select Other Blue Plans for out-of-state policies
  4. Select the applicable Provider name from Express Entry Provider drop-down to auto populate the NPI Field*
  • Complete the following:
    • Provider Type
    • Place of Service

*Use the group NPI rather than the individual provider’s NPI when checking benefits.

Electronic Remittance Advice (ERA)

If a provider is enrolled in ERAs but the Medicare crossover claims drop to paper today, will that history be in Availity like they are under the non-local button in THOR?

Historical ERAs that have been sent via paper will not be available in Availity. However, moving forward, crossover claims that process on the new platform will generate an ERA and will be viewable in Availity.

Are historical remits loaded to Availity?

Six months of ERAs that have been loaded to Availity for providers who have historically had access to electronic remits. If you aren’t working with a clearinghouse and you want to start receiving ERAs, you will need to complete the ERA enrollment process with Availity. 

How do I start receiving my electronic remittance advice (ERA)?

  1. Register and login to Availity
  2. Click My Providers | Enrollments Center | ERA Enrollments
  3. Set up ERA reporting preferences
  4. Click Claims & Payments | EDI Reporting Preferences and then the Claim Payment/Advice tab
  5. Then follow the wizard and click submit. After submitting, you’ll be notified by email that enrollment is complete and you’ll start receiving 835 ERAs through Availity.

In the new system, will professional and institutional remits be delivered together or separately?

Professional and institutional remits will be delivered separately (as they are today).

Can I view electronic remits for out of state BCBS members in Availity?

Yes, out-of-state BCBS claims are part of your BCBSWY ERA and should be available through the Availity Provider Portal. If you are not able to access remits, you should contact Availity Client Services at 1-800-AVAILITY.

Are medical policies changing?

Medical policies have been updated and new ones have been added in an easy-to-use format. These updated policies will offer clarification to authorization requests or claims denials and can be viewed at BCBSWY.com/providers/policy/.

Are prior-authorization requests changing?

Pre-authorization guidelines have been updated and are available at: BCBSWY.com/providers/preadmin/. Please review carefully and make note of the new Authorization Request form and fax number 307-432-2917 to submit authorization requests.

How long can I expect a prior authorization request to take?

The processing time for prior authorizations can take up to two weeks. Eventually, electronic submission of prior authorization requests done through the Availity portal, with an automated review, and should reduce turn-around time (if they meet the required criteria).

Your office will receive an automatic fax response when a determination is made, followed by mail confirmation.

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.

Questions?
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