Concurrent Review Video

Announcements

Concurrent Review Video

We have recently created a video to help you easily navigate the concurrent review process on Availity.

As a reminder, we also have other in-depth training on various Prior Authorization topics. Please click the button below to view them now.

Prior Authorization Videos


Good Habits

Provider Directory Validation Tool 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.

Confirm Today

Provider Directory Validation Tool Reminder
Provider Resources: Availity Directory Validation Training Guide

Availity Is The Place for Authorization Submissions

As a reminder, authorizations should be submitted through Availity.

BCBSWY will no longer accept voicemail, mail, or faxed submissions for authorization requests except for the following items:

  • Any FEP authorization not accepted in Availity.
  • Any authorization triggering an error in Availity that has been reported to Provider Relations by calling 1-888-666-5188.
  • Any authorization for transplant services.
  • Any authorization for our pharmacy team.

All authorizations must be submitted through Availity.

Visit Availity!

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Tips: CPT Code 83036 Billing

Reminder

CPT Code 83036 Billing Tips

As a reminder, Providers should include category II codes when billing CPT code 83036. Claims without the category II codes billed using CPT code 83036 will be denied. They will need to be resubmitted as a corrected claim.

Please use the codes below now to ensure proper categorization.

CPT 83036 for a HbA1c laboratory test will need the appropriate Category II code on the same claim.

CAT II codes are an informational code and should be billed with either a $0.00 charge or a $0.01 charge if required by your system or clearing house.

CAT II codes are for diagnostic/screening processes or results.

Category II Codes for HgbA1c

Code Usage
3044F-HbA1c —– Less than 7.0%
3051F-HbA1c —– Greater than or equal to 7.0% and less than 8.0%
3052F-HbA1c —– Greater than or equal to 8.0% and less than 9.0%
3046F-HbA1c —– Greater than 9.0%

Claim Adjustment Form


Good Habits

Provider Directory Validation Tool 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.

Confirm Today

Provider Directory Validation Tool Reminder
Provider Resources: Availity Directory Validation Training Guide

Availity Is The Place for Authorization Submissions

As a reminder, authorizations should be submitted through Availity.

BCBSWY will no longer accept voicemail, mail, or faxed submissions for authorization requests except for the following items:

  • Any FEP authorization not accepted in Availity.
  • Any authorization triggering an error in Availity that has been reported to Provider Relations by calling 1-888-666-5188.
  • Any authorization for transplant services.
  • Any authorization for our pharmacy team.

All authorizations must be submitted through Availity.

Prior Authorization on Hearing Aids Services

Announcements

Prior Authorization on Hearing Aids Services

Effective 01/01/2024, FEP began requiring Prior Authorization on Hearing Aids services.

To be considered as a covered benefit, prescribed hearing aids must be an FDA approved device and prescription grade. Over-the-counter hearing aids are not a covered benefit.

All authorizations must include the 510(K) number, the name and model of the hearing aid.


Submitting Inpatient Authorizations – Start of Care Date

When submitting inpatient authorizations through the Availity portal, always update the START OF CARE DATE to the member’s admission date for the inpatient level of care. Otherwise, it will default to an incorrect date.

Note: This should not be the date the patient entered the facility or is in an observation status unless you are requesting an observation stay review.

BCBSWY only requires review of observations stays for Federal Employee Program (FEP) members when the observation surpasses 48 hours.


Good Habits

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.

Confirm Today

Provider Directory Validation Tool Reminder
Provider Resources: Availity Directory Validation Training Guide

Change Healthcare Notice

Announcements

We are aware that some Blue Cross Blue Shield of Wyoming members may be experiencing issues accessing some health care services as a result of an incident impacting Change Healthcare—an integral ‘background’ health care delivery vendor that connects payers, providers, and members.

There is no identified risk to Availity Systems, its technology, or Blue Cross Blue Shield of Wyoming.

We are gathering more information as the situation unfolds and continue to take precautions to protect our systems and members. Ensuring the safety and well-being of our members continues to be our top priority.

Availity EDI Update:

Availity has disconnected all inbound and outbound transactions from Change Healthcare as part of their security measures. Availity has shared an alternative path for providers who use Change Healthcare to upload transaction files. Please use the instructions included below.

These instructions can also be found in the Billing and Claims resources section under the provider tab at BCBSWY.com.

Availity Functions:

Our provider portal, Availity, has several functions to assist you, including the following:

  • Verify eligibility and benefits
  • Check claim status
  • Download remittance advice

For additional assistance related to this cybersecurity incident, you can contact Availity directly

Training is available from Availity using the link below.

Availity Training Resources

As we further evaluate the implications of Change Healthcare’s outage, we will keep you updated. Ensuring the safety and wellbeing of our members remains our top priority.

Please reach out to BCBSWY at 800-442-2376 if you require additional assistance.

Availity Transaction File Upload Instructions

Remits No Longer Printed by Request

Announcements

Effective 4/1/2024, the Blue Cross Blue Shield of Wyoming call center will no longer
print remittance advice statements by request.

Availity is the best source for remits.

To sign up for convenient paperless remits log in to Availity and follow these simple steps to register:

  1. Step 1: After Logging in Click “My Providers” then go to “Enrollments Center”
  2. Step 2: Select “ERA Enrollment”
  3. Step 3: Click “Claims & Payment”, select “EDI Reporting Preferences”, click “Claim Payment/Advice tab”.

For those who are not opted into paperless, remits will continue to be mailed.

Good Habits

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.

Confirm Today

Provider Directory Validation Tool Reminder
Provider Resources: Availity Directory Validation Training Guide

February Provider Manual Update

Announcements

Some Users Experiencing Availity Issues for New Members

Blue Cross Blue Shield of Wyoming has updated t he Provider Manual that contains operational policies and procedures to keep you and your staff informed. You can find it at BCBSWY.com/Providers under Provider Resources. We recommend bookmarking this page as the manual is regularly updated and the online version contains the most current information.


Find Your Remits at Availity

Providers should get their remittances from Availity. Availity is the fast and easy service option that is available when you are.

As a reminder, log in to Availity and follow these simple steps to register:

  • Step 1: After Logging in Click “My Providers” then go to Enrollments Center
  • Step 2: Select ERA Enrollment
  • Step 3: Click Claims & Payment Ɩ Select EDI Reporting Preferences Ɩ Click Claim Payment/Advice tab.

Prior Authorization Training Webinar Available

Only one week remains to register for our upcoming virtual training session for Predictal. This webinar is designed to help you maximize your Prior Authorization workflows.

You must register in order to attend. The one-hour training opportunity will begin at noon on Wednesday, Feb. 7, 2024.

Register for Prior Authorization Webinar


Good Habits

Provider Directory Validation Tool Reminder

You can find the Provider Directory Validation Tool 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 to confirm this information every 90 days.

Confirm Today!


Good Habits

Provider Directory Validation Tool Reminder

You can find the Provider Directory Validation Tool 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 to confirm this information every 90 days.

Confirm Today!

Availity: Users Experiencing Issues for New Members

Announcements

Some Users Experiencing Availity Issues for New Members

Some BCBSWY Availity users are experiencing membership error issues when requesting a prior authorization for members effective 1/1/2024. We are currently working with Availity to resolve this. If you encounter an error with your prior authorization request, please submit a fax to us directly to us directly at 307-432-
2917.


Prior Authorization Training Webinar Available

After popular demand, we are excited to announce another virtual training session for Predictal to help you maximize your Prior Authorization workflows.

You must register in order to attend. The one-hour training opportunity will begin at noon on Wednesday, Feb. 7, 2024.

Register for Prior Authorization Webinar


Know The Right Authorization Request

BCBSWY has received numerous questions regarding the Drug Prior Authorization box on Availity. If you see this option, please know this access is used by different payers — it is not used by BCBSWY.

All authorizations, regardless of CPT or HCPCS code, including drugs, should use the AUTHORIZATION REQUEST box.

See image below.

Authorizations and Referals
Authorizations and Referals

Digital Breast Tomosynthesis Billing Tips

BCBSWY will only reimburse Digital Breast Tomosynthesis (DBT) services billed using CPT codes 77063 and G0279. These codes represent DBT being performed as an add-on service.

The following are the four CPT codes that currently represent DBT services:

  • 77061 – Digital breast tomosynthesis; unilateral
  • 77062 – Digital breast tomosynthesis; bilateral
  • 77063 – Screening digital breast tomosynthesis, bilateral; add-on
  • G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral; add-on

Please note: DBT services billed using code 77061 or 77062 will be denied.

Claim Adjustment Form


Good Habits

Provider Directory Validation Tool Reminder

You can find the Provider Directory Validation Tool 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.

Confirm Today!

Ambulance Rate Increases and CPT Code 83036 Billing Tips

Announcements

Holiday Closures

Welcome to 2024!

Please note we will be closed Monday, Jan. 15 in observance of EqualityDay. We will resume business Tuesday, Jan. 16, during our regular hours.


Ambulance Rate Increases

Effective 2/1/2024 we are updating our rates for ambulance services.

  • Ground ambulance services will have a 2.6% increase.
  • In-network air ambulance services will have a 3% increase for transport codes and a 4% increase for mileage codes. Out-of-network air ambulance reimbursement will remain as is.

CPT Code 83036 Billing Tips

As a reminder, Providers should include category II codes when billing CPT code 83036. Claims without the category II codes billed using CPT code 83036 will be denied. They will need to be resubmitted as a corrected claim.

Please use the codes below now to ensure proper categorization.

CPT 83036 for an HbA1c laboratory test will need the appropriate Category II code on the same claim.

CAT II codes are an informational code and should be billed with either a $0.00 charge or a $0.01 charge if required by your system or clearinghouse.

CAT II codes are for diagnostic/screening processes or results.

Category II Codes for HgbA1c

Code Usage
3044F-HbA1c  —– Less than 7.0%
3051F-HbA1c —– Greater than or equal to 7.0% and less than 8.0%
3052F-HbA1c —– Greater than or equal to 8.0% and less than 9.0%
3046F-HbA1c  —– Greater than 9.0%

Claim Adjustment Form

 


Good Habits

Provider Directory Validation Tool Reminder

You can find the Provider Directory Validation Tool 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 ID combinations.

The No Surprises Act (NSA) requires you to confirm this information every 90 days.

Confirm Today!


Availity Is The Place for Authorization Submissions

As a reminder, authorizations should be submitted through Availity.

BCBSWY will no longer accept voicemail, mail, or faxed submissions for authorization requests except for the following items:

  • Any FEP authorization not accepted in Availity.
  • Any authorization triggering an error in Availity that has been reported to Provider Relations by calling 1-888-666-5188.
  • Any authorization for transplant services.
  • Any authorization for our pharmacy team.

All authorizations must be submitted through Availity.

Visit Availity!

CPT Code 83036 Billing Tips – Holiday Closures

Announcements

Holiday Closures

We want to wish everyone a happy holiday season.
Please note our holiday closures below.

  • We will be closed Monday, Dec. 25 in observance of Christmas.
  • We will resume business Tuesday, Dec. 26 during our regular hours.
  • We will be closed Monday, Jan. 1 in observance of New Years Day.
  • We will resume business Tuesday, Jan. 2 during our regular hours.

CPT Code 83036 Billing Tips

BCBSWY would like to remind Providers to include the category II claims when billing CPT code 83036. Starting in 2024, claims without the category II codes billed using CPT code 83036 will be denied. They will need to be
resubmitted as a corrected claim.

Please use the codes below now to ensure proper categorization.

CPT 83036 for a HbA1c laboratory test will need the appropriate Category II code on the same claim.

CAT II codes are an informational code and should be billed with either a $0.00 charge or a $0.01 charge if required by your system or clearing house.

CAT II codes are for diagnostic/ screening processes or results.

Category II Codes for HgbA1c

Code Usage
3044F-HbA1c —– Less than 7.0%
3051F-HbA1c —– Greater than or equal to 7.0% and less than 8.0%
3052F-HbA1c —– Greater than or equal to 8.0% and less than 9.0%
3046F-HbA1c —– Greater than 9.0%

Claim Adjustment Form