Call Center Hours Change in June

Call Center Hours Changing in June

Blue Cross Blue Shield of Wyoming (BCBSWY) provider call center hours will soon change. The new hours will be from 7:30 a.m. to 5 p.m. This change will be in effect June 1, 2022.

BCBSWY Increasing Claims Process Accuracy

In an ongoing effort to ensure high quality claims processing and payment, BCBSWY is taking additional steps to verify the accuracy of payments made to our contracted facilities. Beginning in July 2022, BCBSWY will begin auditing DRG claims and associated medical records to ensure payments were applied in accordance with national correct coding standard rules.

BCBSWY has contracted with Cotiviti to assist us in this effort. If you have DRG claims selected for audit, you will receive a letter from Cotiviti requesting medical records for these claim audits on behalf of BCBSWY.

The Provider Directory Validation Tool is Ready

In order to help facilitate compliance with the No Surprises Act (NSA) provider directory validation requirements, BCBSWY has developed a Directory Validation tool on the Availity Portal.

This tool allows you to review and confirm name, address, contact information, and providers affiliated with your organization online. The NSA requires you confirm this information with us every 90 days so your information can continue to be listed in our public directory. Please see the guide here.

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Provider Update – Redirection of Care & Holiday Closures

Redirection of Care

Blue Cross Blue Shield of Wyoming is introducing a new redirection of care program for certain medications. When clinically appropriate services will be authorized in the most cost-effective setting, such as an Infusion Center, providers office, or via Home Health. If needed, BCBSWY will assist members with finding an appropriate site for care.

Please note, redirection of care does not affect your patient’s prescription drug benefits.

If a member is affected by this program, it will be noted in the authorization letter. 

Who is Impacted:
As of January 1, 2022, the list below are the medications that will be subject to the redirection of care program for administration in the most cost-effective setting:

Neulasta Remicade
Avastin Rituxab
Herceptin Keytruda
Ocrevus Opdivo
Somatuline Soliris

This program will go into effect with new prescriptions or upon authorization renewal. Typically, medical authorizations expire one year from the date of the authorization.          

Questions:

We have a Redirection of Care Team. If you’re currently taking one of these medications and have questions or concerns, please call 307-823-6095.

Upcoming Holiday Closures

BCBSWY will be closed on Friday, December 24 and Friday, December 31 in observance of the Christmas and New Year holiday.

Redirection of care Infusion Drugs

Blue Cross Blue Shield of Wyoming is introducing a new redirection of care program for certain medications. The prescription drugs listed below will be authorized when clinically appropriate in the most cost-effective setting.

If administration of the list of drugs below are not approved to be performed in an inpatient or outpatient hospital setting you can either redirect the infusion to a lower level cost of care such as free-standing infusion center, doctor’s office, pharmacy, or via home health. Failure to receive the service in an approved location could result in denial of claims.

Please be advised that while the service has been approved as medically appropriate, the member’s benefits require this service be provided in specific locations. 

If needed, our Redirection of Care Team can assist members with finding an appropriate site for care. Our team is available Monday-Friday, 8:00 am-5:00 pm, by calling (307) 823-6095 to assist you.

Please note, redirection of care does not affect your patient’s prescription drug benefits.

If a member is affected by this program, it will be noted in the authorization letter. 

Who is Impacted:
As of January 1, 2022, the list below are the medications that will be subject to the redirection of care program for administration in the most cost-effective setting:

RemicadeRituxab
AvastinKeytruda
HerceptinOpdivo
OcrevusSoliris
Somatuline 

This program will go into effect with new prescriptions or upon authorization renewal. Typically, medical authorizations expire one year from the date of the authorization.

Questions:
We have a Redirection of Care Team. If you’re currently taking one of these medications and have questions or concerns, please call 307-823-6095.

Availity Provider Portal
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Prior Authorization Requests

Propose inpatient stay and request specified services easily through Availity.

Participants 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 prior authorization for health care services and is NOT A GUARANTEE OF PAYMENT. To verify coverage or benefits or determine prior authorization requirements for a participant, call 1-800-442-2376 or send an electronic inquiry through your established connection with your local Blue plan.

Admission Request

Notify BCBSWY of a proposed inpatient stay.

Appeals and Peer-to-Peer Conversations

Request appeals for denied authorization requests or services.

Dental Authorizations

Prior Authorization Request Form

Redirection of Care Infusion Drugs

Includes Redirection of Care Exemption Form.

Rx Authorization Request​

Service Request

Request approval from BCBSWY for specified services.

Availity Provider Portal
Submit Prior Authorization requests online.
Provider Resources

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Provider Update – Codes, ID Cards and Closures

Provider Directory

Beginning Jan. 1, 2022, provider directory information must be reviewed and validated every 90 days, in accordance with the No Surprises Act. The information we’ll be looking for includes name, address, specialty, telephone number, and digital contact information of each health care provider or health care facility. Very soon, BCBSWY will share information on a new tool available in Availity to validate this information.

COVID-19 Vaccine Codes Updated

BCBSWY recently updated our COVID-19 vaccine codes to include pediatric vaccine codes. To review this information, click here.

Reminder! BCBSWY Member ID Cards

BCBSWY Member ID cards now include the amount of the in-network and out-of-network deductibles and out-of-pocket maximums. Subscriber numbers have not changed, however, please note that BCBSWY Members may offer their new Member ID card at their next medical appointment.

Upcoming Holiday Closures

BCBSWY will be closed on Thursday, November 25 and Friday, November 26 in observance of the Thanksgiving holiday.

 

BCBSWY Mailing Address:

PO Box 2266, Cheyenne, WY  82003-2266

Blue Cross Blue Shield of Wyoming is an independent licensee of the Blue Cross and Blue Shield Association

Practice Office Information

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2020 Update
BCBSWY Provider Manual

Telemedicine Services

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2020 Update
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New! COVID-19 Test Billing Guidance

The Families First Coronavirus Response Act (the FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act) require health plans to cover diagnostic testing of COVID-19. Coverage must be provided without any cost-share, prior authorization, or medical management requirements. The table below is provided to help understand which billing codes are appropriate for these services. Please note that antibody testing is appropriate as a diagnostic test in limited circumstances and will not be a benefitable service when conducted for return to work or surveillance purposes.

Asymptomatic and pre-surgical COVID-19 diagnostic testing is covered when medically appropriate and supported by the accepted standards of current medical practice.

See updates from 1/27/2021 below in red.

Test Type HCPCS/CPT Code Providers Eligible to Bill Is cost share waived? Is it a benefit?

COVID-19 Diagnostic Test

CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel U0001 CDC, State Lab YES YES
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC U0002 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making
use of high throughput technologies
U0003 Laboratories only YES YES
2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple
types or subtypes (includes all targets), non-CDC, making use of high throughput technologies
U0004 Laboratories only YES YES
Infectious Agent Detection By Nucleic Acid (DNA Or RNA); Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Amplified Probe Technique, CDC Or Non-CDC, Making Use Of High Throughput Technologies, Completed Within 2 Calendar Days From Date Of Specimen Collection (List Separately In Addition To Either HCPCS Code U0003 Or U0004) U0005 Laboratories only YES YES
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique 87635 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) (Coronavirus disease [COVID-19])

and influenza virus types A and B, multiplex

amplified probe technique

87636 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Severe acute respiratory syndrome coronavirus 2

(SARS-CoV-2) (Coronavirus disease [COVID-19]),

influenza virus types A and B, and respiratory

syncytial virus, multiplex amplified probe technique

87637 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious agent antigen detection by immunoassay

technique, qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg,

SARS-CoV, SARS-CoV-2 [COVID-19])

87426 Physician Offices, Urgent Care, Labs, Hospitals YES YES
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 87811 Physician Offices, Urgent Care, Labs, Hospitals YES YES

Rapid COVID-19 Diagnostic Test

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC U0002-QW Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique 87635-QW Physician Offices, Urgent Care, Labs, Hospitals YES YES

Proprietary Lab Codes

Infectious disease (bacterial or viral respiratory

tract infection), pathogen-specific nucleic acid

(DNA or RNA), 22 targets including severe

acute respiratory syndrome coronavirus 2

(SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported

as detected or not detected

 

BioFire® Respiratory Panel 2.1 (RP2.1), BioFire® Diagnostics, BioFire® Diagnostics, LLC

 

BioFire® Respiratory Panel 2.1- EZ (RP2.1-EZ), BioFire® Diagnostics, BioFire® Diagnostics, LLC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0202U

 

 

 

0202U-QW

 

 

 

Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected

 

QIAstat-Dx Respiratory SARS CoV-2 Panel, QIAGEN Sciences, QIAGEN GmbH

0223U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed

 

COVID-19 Antibody Test, Mt Sinai, Mount Sinai Laboratory

0224U Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected

 

ePlex® Respiratory Pathogen Panel 2, GenMark Dx, GenMark Diagnostics, Inc

0225U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum

 

Tru-Immune™, Ethos Laboratories, GenScript® USA Inc

0226U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected

 

Xpert® Xpress SARSCoV-2/Flu/RSV (SARS-CoV-2 & Flu targets only), Cepheid

0240U Physician Offices, Urgent Care, Labs, Hospitals YES YES
Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected

 

Xpert® Xpress SARSCoV-2/Flu/RSV (all targets), Cepheid

0241U Physician Offices, Urgent Care, Labs, Hospitals YES YES

Specimen Collection

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source G2023 Laboratories only YES YES
– Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source G2024 Skilled Nursing
Lab on behalf of a Home Health Agency
YES YES
Hospital Outpatient clinic visit specimen collection for severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus disease[COVID-19]), any specimen source C9803 Hospital Outpatient YES YES
Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory 99000 Physician Offices YES YES
Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory 99001 Mobile Unit
Walk-in Retail Health Clinic
Urgent Care
Emergency Room Hospital
Drive through testing
YES YES

Antibody Tests

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 86328 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Neutralizing antibody, severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen

86408 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID19]); screen titer

 

86409 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment
Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 86769 Physician Offices, Urgent Care, Labs, Hospitals Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment Not covered unless the test is medically appropriate for diagnostic purposes based on an individual assessment

COVID-19 Billing Guidance – UPDATE!

COVID-19 Billing Guidance – UPDATE!

In order to ensure the proper cost share waiver of your COVID-19 testing claims, BCBSWY asks that providers include specimen handling codes on the claim if you are not performing these tests in-house. Providers can submit a corrected claim if these services were performed but omitted from previous claims.

Acceptable specimen handling codes are: G2023, G2024, C9803, 99000, and 99001. See COVID-19 Billing Guide for more details.

Please do not bill nurse level visits (99201 and 99211) in lieu of specimen collection codes, as these codes may not be properly identified as requiring cost share waivers.

For claims with treatment of COVID-19 defined as U07.1, BCBSWY will waive inpatient prior authorization requirements. Cost share waivers are dependent on a member’s benefit plan – see below for more information.

BCBSWY COVID-19 Response

Telemedicine

Because the health and safety of our community is of upmost of importance, BCBSWY continues to encourage telemedicine visits.

  • BCBSWY has extended our telemedicine benefits, including waiving member cost share,
    effective until August 31, 2020. Expanded telemedicine benefits include all BCBSWY fully
    insured members but is optional for self-funded plans.
  • For additional information on how BCBSWY is processing telemedicine benefits view this matrix.

COVID-19 Treatment

  • BCBSWY has extended our commitment to waive all member cost sharing and copayments for treatment, and inpatient hospital admissions, due to the diagnosis of COVID-19 for all fully insured members but is optional for self-funded plans, effective 4/1/20-8/31/20.

COVID-19 Testing & Billing

The Families First Coronavirus Response Act (the FFCRA) and the Coronavirus Aid, Relief, and
Economic Security Act (the CARES Act) require health plans to cover diagnostic testing of COVID-19.

  • Coverage must be provided without any cost-share, prior authorization, or medical management requirements.
  • View our billing guidance to understand which billing codes are appropriate for testing services.
  • Antibody testing is appropriate as a diagnostic test in limited circumstances and will not be a benefitable service when conducted for return to work or surveillance purposes.
  • Asymptomatic and pre-surgical COVID-19 diagnostic testing is covered when medically appropriate and supported by the accepted standards of current medical practice.

Stay Informed!

  • Very soon BCBSWY will be launching a new public website. Our web address will stay the same, www.BCBSWY.com, but the look will be updated and provider information will be organized by clinical resources and office resources. It’s intuitive to use and we hope you can easily find what you need but let us know if you need help finding something!

For more information see: CDC COVID-19 or State of Wyoming COVID-19.

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