Timely Filing & Individual Claims

Timely Filing Reminder  

BCBSWY would like to remind providers we have a timely filing deadline of one year from the date of service. However, some groups have a deadline of less than a year. Therefore, we encourage providers to submit claims within 60 days of the date of service as timely filing may impact benefit determination.

 

Bill Claims Individually 

BCBSWY does not accept roster billing. All claims must be submitted individually.

 

Holiday Closure

Our offices will be closed on Monday, July 4 in observance of Independence Day.

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.

Wyoming Blue Circle of Excellence 

For Ambulatory Surgical Centers Knee and Hip Replacement

Frequently Asked Questions

We appreciate your interest in the Blue Circle of Excellence for Knees and Hips evaluation process, please thoroughly review this entire application and the supplemental instructions for more details. 

The application process to be evaluated as a Wyoming Blue Circle of Excellence for Knees and Hips is available throughout the year.

We encourage all interested providers to complete the Wyoming Blue Circle of Excellence application for our team to evaluate if you meet the qualification criteria. Please review the application and instructions to gather the information required before submitting online. The online survey must be completed in the same session. Contact provider.relations@bcbswy.com for more details.

Designation as a Wyoming Blue Circle of Excellence Center differentiates you among peers in your community and around the state. From staff and referring physicians to patients and prospective employees, this highly respected designation affirms your program’s expertise in delivering higher quality and more affordable health care for their knee and hip replacement needs. 

BCBSWY is committed to providing consumers and physicians with increased transparency on provider quality and cost. Wyoming Blue Circle of Excellence designations provide consumers and their referring physicians with the information they need to select a provider recognized for delivering quality, cost-efficient specialty care.

Employers also adopt many tactics to help improve the quality of health care for their employees, while also managing cost. Some of these tactics may include offering richer benefits to employees who use designated WY Blue Circle of Excellence providers.

After an initial award, successful applicants must reapply 90-days before the award expiration to continuously remain in the program. The Wyoming Blue Circle of Excellence program award period is three years after the initial award date. Reapplication is required for on-going participation. This process allows all providers to be evaluated against the same selection criteria.

The evaluation process for Blue Circle of Excellence is a win-win proposition for providers. Whether they meet the program selection criteria or not, every provider evaluated receives a customized report providing useful and critical insights into its performance.

Upon completion of the Participation Agreement a toolkit of promotional resources will be made available. Including a sample press release template, social media posts, artwork, and information about how the ASC can promote the designation. BCBSWY will also assist with coordination of the announcement to help amplify this designation to members and employers.  

If you are not accepted into the program, you will receive a report that can provide a foundation for internal discussions with your executive management or medical staff. This report can be used as a tool to assess and improve your program’s quality and cost performance through comparisons to national benchmarks. Applicants may reapply six months after an unsuccessful application or after application issues have been resolved, whichever is later.

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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
Submit Prior Authorization requests online.
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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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