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.

How does my ASC earn the Wyoming Blue Circle of Excellence recognition?

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 [email protected] for more details.

What are the advantages of Wyoming Blue Circle of Excellence Designation?

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.

How frequently must Providers apply for this program?

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.

What are the benefits of Blue Circle of Excellence benchmarking?

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.

How will a Wyoming Blue Circle of Excellence designation be promoted?

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.

What if I apply and do not receive a designation?

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.

Site of Care Infusion Drugs

Blue Cross Blue Shield of Wyoming’s site of care program requires certain services that may have been received in a hospital setting to now only be authorized in the most cost-effective setting, such as an infusion center, provider’s office, or via home health including the use of subcutaneous injectables. If needed, BCBSWY will assist members with finding an appropriate site for care. All medications under this program require Prior Authorization.

If administration of the list of drugs below are not approved to be performed in an inpatient or outpatient hospital setting members can receive infusion treatments at facilities 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 the denial of claims. The financial responsibility of the denied amount will be the members responsibility.

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

If needed, our Site 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.

IVIG

Non-IVIG

IVIG

Non-IVIG

Preferred Product Program

Some members may be required to receive preferred medications, including biosimilar medications for coverage under their health plan. Preferred medications offer the same safety and effectiveness but at a lower cost, keeping health care costs lower.

Many preferred medications below are called biosimilar medications which are made from livin organisms such as animal or plant cells, bacteria, or yeast, rather than being chemically synthesized like similar medications.

Drug Class	Preferred Product (2027 Changes in Bold)
Bevacizumab	2026: Mvasi & Zirabev 2027: Mvasi, Zirabev, Vegzlema
Rituximab	2026: Ruxience, Truxima, Riabni 2027: Ruxience, Truxima, Riabni
Infliximab	2026: Avsola, Inflectra 2027: Avsola, Inflectra, Renflexis
Viscosupplements	2026: Durolane, Gelsyn-3, Supartz, Gel-One, Visco-3 2027: Durolane, Gel-One *(Note: Gelsyn-3, Supartz, and Visco-3 are no longer preferred medications)*
Immune Globulins IV	2026: Octagam, Gemmaked, Gamunix-C, Gammargard, Privigen 2027: Octagam, Gemmaked, Gamunix-C, Gammargard, Privigen
Immune Globulins SC	2026: Hyqvia, Hizentra, Xembify, Cutaquig 2027: No preferred medication. Any medication in this category may be used for members.
Ustekinumab	2026: Selarsdi, Yesintek, Steqeyma 2027: Selarsdi, Yesintek *(Note: Steqeyma is no longer a preferred medication)*
Infused Iron	2026: Feraheme, Ferrlecit, INFed, Venofer 2027: Feraheme, Ferrlecit, INFed, Venofer
Trastuzumab	2027: Kanjinti, Ogivri
Filgrastim	2027: Zivestym, Zerxio
Pegfilgastim	2027: Fulphila, Udenyca
Lupus	2027: Venlysta (IV), Saphnelo (SC)
Denosumab Biosimilars (Xgeva)	2027: Biloprevda, Xtrenbo
Denosumab Biosimilars (Prolia)	2027: Bildyos, Enoby
Injectable Asthma	2027: Nucala, Fasenra
Ocular VEGF	2027: Bevacizumab (Note: There is no prior authorization necessary for Ocular VEGF)

Prior Authroization

Many of the preferred medications above require prior authorization. To review prior authorization requirements and submit an authorization go to Availity.com.

Effective Date of Preferred Products

We encourage all providers to provide the preferred products for our members starting January 1, 2027. Enforcement of the program will go into effect with new medication prior authorizations or upon authorization renewal. If you need help with a census of members who need to transition in 2027, please reach out to our CarePath team.

Exceptions

Member safety is our top priority. If you feel a member may need an exception due to a contraindication, please submit this documentation with your prior authorization. If you need assistance outside of the prior authorization process, please contact our CarePath medication team at 307-823-6095.

General Questions:
The CarePath medication team is available to members and providers. If you’re currently taking one of these medications or prescribing these medications and have questions or concerns, please call 307-823-6095.

Availity Provider Portal

Submit Prior Authorization requests online.

Go to Availity

Site of Care Form

Submit an exemption form.

Submit

Provider Resources

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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.

Continuity of Care for Enrollees – Authorization Transfer Request

This form is used to request transfer of authorization from a previous insurance carrier to BCBSWY.

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

Verify elgibility and benefits, submit claims, and more.

WyoBlue Advantage

Access the WyoBlue Advantage provider portal, find WyoBlue information, news, and more.

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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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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!

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.

Wyoming Blue Circle of Excellence

For Ambulatory Surgical Centers Knee and Hip Replacement

Explore our Provider Network

Provider News

Sign Up to Receive Provider News Updates

Availity Provider Portal

WyoBlue Advantage

Provider Resources

Ready to join our network?

Site of Care Infusion Drugs

Preferred Product Program

Availity Provider Portal

Site of Care Form

Provider Resources

Ready to join our network?

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.

Admission Request

Appeals and Peer-to-Peer Conversations

Continuity of Care for Enrollees – Authorization Transfer Request

Dental Authorizations

Prior Authorization Request Form

Redirection of Care Infusion Drugs

Rx Authorization Request​

Service Request

Availity Provider Portal

WyoBlue Advantage

Provider Resources

Ready to join our network?

Practice Office Information

Contact Provider Services

Fewer Hassles. Better Service.

2020 Update

Telemedicine Services

Contact Provider Services

Fewer Hassles. Better Service.

2020 Update

COVID-19 Billing Guidance – UPDATE!

BCBSWY COVID-19 Response

Telemedicine

COVID-19 Treatment

COVID-19 Testing & Billing

Stay Informed!

ACA – Online Event Registration Form

Rx Authorization Request