| Effective July 1, 2025, Blue Cross Blue Shield of Wyoming (BCBSWY) will update the process for how providers bill L8699.
Currently, L8699 providers bill the charge of the implants and provide a copy of the invoice. BCBSWY reimburses the invoice cost plus 10% based on the invoice and is paid prior to processing the claim. Starting July 1, 2025, BCBSWY will no longer require a copy of the invoice for L8699 implants before processing the claim. BCBSWY will process L8699 claim lines for charges billed by the provider. Providers should price their charges for L8699 with the cost of the implant plus 10% like the example below: L8699 implant invoice cost is $1,000. The provider should bill L8699 for $1,100 in charges. BCBSWY will NOT reimburse separately for implants if the total cost is less than $750.00. Implants with a total cost less than $750.00 will deny as included in with the procedure billed. BCBSWY will perform frequent post-pay audits. If audits are not successful, provider may be removed from the new process and required to submit all invoices for L8699 as before. Invoices and operative notes may also still be requested from other Blues plans for their members for their benefit reviews. Individual provider outreach will be conducted by the BCBSWY Provider Relations teams to help assist with this transition. For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or email [email protected]. Register Now!Social Determinants of Health Webinar
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Site Section: Providers
Provider Updates Moving Platforms
BCBSWY is in the process of transitioning our communications from Constant Contact to Salesforce Marketing Cloud. This is a much-needed upgrade to serve our members and providers efficiently, professionally, and with the best technology available. As a valued provider this will be a seamless process, but you may notice different URLs and originating emails. For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or [email protected].
WEBT Members on the Move
Effective July 1, 2025, BCBSWY Wyoming Educators’ Benefit Trust (WEBT) members are moving to the Wyoming Total Choice network. All WEBT members will receive new member cards and are aware of this upcoming change in their BCBSWY health insurance plan. We recommend that you continue to request the WEBT member present their health insurance card at every visit. For questions regarding this change please contact Provider Relations at 1-888-666-5188 or [email protected].
Understanding Labs Webinar
The Understanding Labs Webinar on April 23, 2025, was a success. The webinar was geared toward primary care and family practices and they
learned about laboratory benefits including cost share, medically unlikely edits, and frequency limitations. Also covered was how to bill, what modifiers affect payment, and where to bill a claim for labs utilizing the BlueCard System. Explanation of how CLIA Certificate of Waiver effects reimbursement and coding requirements was also covered and how BCBSWY is educating members, so they understand that not all labs are preventive. There was plenty of time for the BCBSWY Director of Population Health, and webinar presenter to answer questions.
Due to the popularity of the webinar, we have included a recording below.
| Webinar Recording 4/23/2025 |
Provider News
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Redirection of Care Update – addition of Saphnelo
| Effective May 1, 2025, Blue Cross Blue Shield of Wyoming (BCBSWY) will add the following medication to the Redirection of Care program.
Saphnelo (HCPCS Code J0491) Saphnelo is a prescription medicine used to treat adults with moderate to severe SLE who are receiving other lupus medicines. BCBSWY Medical Policy 12.01.002 has been updated with the following information. There is no change in the medical necessity criteria. However, a tagline will be added to the top of the medical policy to notate that this medication is a part of the Redirection of Care program as of 5/1/2025. Click here to view the whole medical policy. FEP Medical Policy 5.99.023 has also been updated accordingly. Click here to view the whole medical policy. As a reminder, information related to the Redirection of Care program can be found on our website at SITE OF CARE INFUSION DRUGS. For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or email provider.relations@bcbswy.com. |
Register NOW! Understanding Labs Webinar
| Register NOW! Understanding Labs Webinar
Click below to register for the upcoming Understanding Labs Webinar 12 p.m. – 1 p.m. MST, Wed., April 23, 2025 · Learn about laboratory benefits including cost share, medically unlikely edits, and frequency limitations. · We’ll cover how to bill, what modifiers affect payment, and where to bill a claim for labs utilizing the BlueCard System. · Understand how CLIA Certificate of Waiver effects reimbursement and coding requirements. · How BCBSWY is educating members, so they understand that not all labs are preventive. |
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SURGICAL REIMBURSEMENT UPDATE
Updated Rates for Health Care Professionals
Effective July 1, 2025, Blue Cross Blue Shield of Wyoming (BCBSWY) will implement new rates for all surgery services, provided by physicians, to align with the Resource-Based Relative Value Scale (RBRVS) payment system. At this time, our Ambulatory Service Center (ASC) rates will remain the same. The change will allow us to better maintain our rates over time and to provide more consistency in how emerging services are reimbursed.
These new relative values will result in a more consistent relationship between rates for related services.
BCBSWY will be establishing a clear differential in our surgical rates to favor lower cost settings. To support that, BCBSWY will be implementing a site of service differential on all codes where it is supported by RBRVS to encourage in-office surgery where possible. Additionally, BCBSWY will be implementing a differential to benefit surgeons who perform services in ambulatory surgical centers.
Rates for individual codes may increase or decrease, depending on the rate’s current relationship to RBRVS. Due to the changes in individual codes, results may vary, and some providers may see a net increase or decrease for these surgery services.
For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or email [email protected].
Register NOW! Understanding Labs Webinar
Mark your calendars for our upcoming webinar Understanding Labs
12 p.m. – 1 p.m. MST, Wed., April 23, 2025
- Learn about laboratory benefits including cost share, medically unlikely edits, and frequency limitations.
- We’ll cover how to bill, what modifiers affect payment, and where to bill a claim for labs utilizing the BlueCard System.
- Understand how CLIA Certificate of Waiver effects reimbursement and coding requirements.
- How BCBSWY is educating members, so they understand that not all labs are preventive.
| Register Now |
Evaluation & Management Reimbursement Update
Effective June 1, 2025, BCBSWY is implementing an increase in reimbursement in the areas of Evaluation and Management (E&M).
For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or email [email protected].
Hospice Reimbursement Update
Effective July 1, 2025, BCBSWY is implementing an increase in reimbursement in the areas of Hospice for the following Revenue Codes:
- Revenue Code 651
- Revenue Code 652
- Revenue Code 655
- Revenue Code 656
- Revenue Code 659
For questions regarding these changes please contact Provider Relations at 1-888-666-5188 or email [email protected].
Understanding Labs Webinar Save the Date
Mark your calendars for our upcoming webinar Understanding Labs
12 p.m. – 1 p.m. MST, Wed., April 23, 2025
- Learn about laboratory benefits including cost share, medically unlikely edits, and frequency limitations.
- We’ll cover how to bill, what modifiers affect payment, and where to bill a claim for labs utilizing the BlueCard System.
- Understand how CLIA Certificate of Waiver effects reimbursement and coding requirements.
- How BCBSWY is educating members, so they understand that not all labs are preventive.
Details on how to register to come.
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
No Surprises Act (NSA) requires you confirm this information every 90 days.
DME Reimbursement Update
BCBSWY is updating its DME reimbursement rates. Effective June 1, 2025, our DME reimbursement will be based on Medicare’s DMEPOS 2024 non-rural schedule.
- Reimbursement for respiratory equipment will be set at 140% of the fee schedule.
- Reimbursement for non-respiratory equipment will be set at 100% of the fee schedule.
Understanding Labs Webinar Save the Date
Mark your calendars for our upcoming webinar Understanding Labs
12 p.m. – 1 p.m. MST, Wed., April 23, 2025
- Learn about laboratory benefits including cost share, medically unlikely edits, and frequency limitations.
- We’ll cover how to bill, what modifiers affect payment, and where to bill a claim for labs utilizing the BlueCard System.
- Understand how CLIA Certificate of Waiver effects reimbursement and coding requirements.
- How BCBSWY is educating members, so they understand that not all labs are preventive.
Details on how to register to come.
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
No Surprises Act (NSA) requires you confirm this information every 90 days.
Updated Provider Directory Validation Training Guide
We made updates to the Provider Directory training guide due to some changes on the Availity site. We worked through the guide with providers and found areas where the additional wording would be helpful. The updated version has been posted to the website and is available by clicking the button below.
Provider Directory training guide
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
No Surprises Act (NSA) requires you confirm this information every 90 days.
Preventive and Medical Billing Guidelines
Due to popular demand, we’ve increased visibility and access to the Preventive and Medical Billing Guideline PDF. The button below will take you directly to the PDF. The second button will take you to our Provider Page where we keep the most current Billing and Claims Guidelines and Resources so you can access many more information here.
Prior Authorization Updates
Blue Cross Blue Shield of Wyoming (BCBSWY) is committed to providing our Provider community with updates and best practices to improve the processes required to submit prior authorizations for your patients.
We understand that the prior authorization process can be confusing. Here are some important updates to know about:
New Medical Policies: BCBSWY has recently updated posted medical policy updates effective 2/1/25. Click here to view these updates.
Drug prior authorization requests: Recent changes in the process for drug prior authorization requests have occurred due to updates with one of our vendors.
Review the following steps clarify the procedures for submitting a pharmacy prior authorization. Please note that step two is a temporary workaround while we review potential solutions. We hope this helps reduce some of the confusion caused by the recent changes.
Submitting a Pharmacy prior authorization:
1: For Members with Prefixes ZSF, QWY, or ZSK:
- Submit the request through covermymeds®.
2: For Members with IDs Starting with ZRW, ZSD, ZWY, or YWY:
- Complete the correct pharmacy prior authorization form from MyPrime and save it as a PDF.
- Fill out the Availity request with the following key points:
- Do not use the covermymeds link. Use “Authorization Request.”
- The request type is “Outpatient” Authorization.
- If the drug doesn’t have its own HCPCS code, use “J3490 – Unclassified Drugs” for the procedure code.
- Complete provider details.
- Upload the saved drug-specific form under “Recent attachments.”
- Complete the rest of the Availity form.
If you would like additional information, please click on the button below. This is a step-by-step guide for submitting BCBSWY pharmacy prior authorizations through Availilty.
FEP PRIOR AUTHORIZATIONS
We are aware that FEP in-patient authorization letters are being sent without member information. To view FEP authorization status login to the Availity provider portal and use the Authorization Dashboard to find the status.
A solution has been identified, and work is in progress to correct this technical issue.
IMPORTANT DATES
Upcoming Business Hours & Closures
Tuesday, Dec. 24: Closing at noon
Wednesday, Dec. 25: Closed
Tuesday, Dec. 31: Closing at 3:00 p.m.
Wednesday, Jan. 1: Closed
Preventive Visits Webinar – January 15, 2025
This webinar is geared toward primary care and family practices. BCBSWY will review coding requirements, including proper CPT codes and diagnosis codes to ensure correct billing practices. This, in addition to proper coding for sick visits when combined with annual wellness visits and the reimbursement policy.
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
No Surprises Act (NSA) requires you confirm this information every 90 days.
Coding Update – J3490
Effective 10/1/24 prior authorizations using dump code J3490 can no longer be used if the requested drug is listed on the BCBSWY redirection of care (ROC) list. Prior authorizations using J3490 will be rejected, using the appropriate HCPCS code will correct this issue.
Provider Directory Validation Reminder
You can find the Provider Directory Validation guide under the Provider Resources section on the right rail of the website.
Providers can use the Directory Validation tool on the Availity Portal to find NPI and tax ID combinations.
The No Surprises Act (NSA) requires you confirm this information every 90 days.
Prior Authorization Tip
Availity Users: Here is how to use the Authorization/Referral Inquiry and the Authorization/Referral Dashboard in Availity:
- Inquiry allows users to search for any authorizations that they have submitted/edited individually
- Dashboard allows users to search for an authorization submitted by any user assigned to your organization
Updated: The BCBSWY Provider Manual Prior Authorization section was updated to reflect current review timelines. Find the new version here.
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