To find medical policies or general precertification/preauthorization information for out of area members:
Select one:
If you experience difficulties or need additional information, call 800.676.BLUE.
Because the health and safety of our community is of upmost of importance, BCBSWY continues to encourage telemedicine visits.
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.
BCBSWY encourages members to explore mail-order options for your prescription refill needs.
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.
Please complete this form to request a participating provider application.
To become a participating provider with Blue Cross Blue Shield of Wyoming, your participating address must be within Wyoming.
Provider Questions, Answered.
Our goal is to answer your inquiry within two business days, but additional time may be needed for requests requiring complex research or additional information. Confidential information will be responded via telephone or postal mail.
Please do not include personal health information or sensitive information such as a social security number.
Verify elgibility and benefits, submit claims, and more.
Access the WyoBlue Advantage provider portal, find WyoBlue information, news, and more.
We are always interested in your feedback and how we can serve you better.
Blue Cross Blue Shield of Wyoming (BCBSWY) would like to recognize you and your colleagues for your efforts in addressing the COVID-19 pandemic. As we know, it is an unprecedented global and national public health crisis that has strained health systems around the world and here in Wyoming. It has caused extraordinary economic upheaval.
Your efforts to ramp up testing, conserve PPE, adopt telemedicine, and support your communities to help minimize the spread of this disease have not gone unnoticed. We truly appreciate your efforts and want to thank you for what you have done, and what we know you will continue to do during this crisis.
We understand that testing is one of the most valuable tools available to providers to help control this disease. As we work to restore economic activity in Wyoming, it is important to understand the types of testing available and what seems to be the most appropriate use.
We know the science and policy of this novel disease is continually changing. We will do our best to keep you informed of changes from our side that may affect you. We are committed to doing our share to ensure the health and well-being of our members, and we look forward to helping you do the same.
Again, we thank you for your dedication to the care our members and to all residents of Wyoming.
Respectfully,
Joseph Horam, M.D.
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.
As you may know, 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.
Please click here to see a table to help understand which billing codes are appropriate for COVID-19 testing and how to bill for these services.
You can find additional information about BCBSWY’s COVID-19 response at BCBSWY.com/providers/updates or in the Availity.com BCBSWY Payer Space—including the following:
For more information see: CDC COVID-19 or State of Wyoming COVID-19
Questions? This guideline details what you need to know.
If the service is a dental service and the member has a new member ID, the service should be submitted on a dental claim form to UCD. The service will deny as ‘no coverage’ but then should interface to BCBSWY medical, provided the service has a secondary coverage of medical and the member has active medical coverage.
Dental Claims Administrator
PO Box 69406
Harrisburg, PA 17106-9406
Please submit to UCD at:
Dental Customer Service – Appeals
PO Box 69420
Harrisburg, PA 17106-9420
Or call 1-844-653-4057
Please follow the BCBSWY appeals process.
Register for My Patients’ Benefits at: wy.ourdentalcoverage.com and submit your claims electronically through Speed eClaim®
For questions related to electronic claim submission via Speed eClaim® or through your Practice Management Software Vendor or Clearinghouse, please contact Dental Electronic Services at 800-633-5430.
The BCBSWY Payer ID is 53767. If you don’t recognize this Payer ID, contact your Practice Management Software Vendor or Clearinghouse.
If you are directly contracted with BCBSWY OR you are contracted with both BCBSWY and United Concordia Advantage Plus, you will be reimbursed based on your existing BCBSWY schedule. If you are only contracted with United Concordia Advantage Plus, you will be reimbursed according to the United Concordia Maximum Allowable Charge schedule.
Patient information such as eligibility, benefits, claim status, maximums/ deductibles, procedure history, procedure code information, orthodontic information and Maximum Allowable Charge schedules can be obtained through My Patients’ Benefits and can be accessed at wy.ourdentalcoverage.com
Predeterminations will be valid for 1 year from when the service was approved. Providers can insert the date of service in My Patients’ Benefits via the Claim Status feature; or can insert the date of service on the Predetermination Notification form and return it via the USPS.
United Concordia will be reviewing pre-authorization requests for medically necessary orthodontia using United Concordia criteria.
Dental Claims Administrator
PO Box 69401
Harrisburg, PA 17106-9401
Paper claims can be submitted on an ADA 2012 or ADA 2019 form. Be sure to include the BCBSWY Member ID on the form. If paper dental claims are submitted to BCBSWY in Cheyenne, they will be returned to the dental office and need to resubmit to UCD directly.
Use codes D7220, D7230, or D7240. Anesthesia should be billed using D9222 for the first fifteen minutes. For each additional fifteen minutes bill using D9223 and the appropriate number of units.
Example: One hour of anesthesia; the first would be D9222 (FIRST 15 MINUTES) then D9223 (EACH SUBSEQUENT 15 MINUTE INCREMENT) with units showing as 3.
If the extraction codes crossover, then the anesthesia codes will crossover as well.
For FEP claims please submit appeals to BCBSWY.
If you are in need of help with HCPCS or CPT codes call Provider Support at 888-359-6592 or email [email protected].
Verify elgibility and benefits, submit claims, and more.
Access the WyoBlue Advantage provider portal, find WyoBlue information, news, and more.
United Concordia is an independent company providing administrative services for Blue Cross Blue Shield of Wyoming members and providers.
Working together for better health care
As the leader in security and stability for over 70 years, BCBSWY is transforming health care through Patient-Focused Care. We’re partnering with our Wyoming physicians to encourage care coordination and better health management.
Innovative Patient-Focused Care programs help hold the line on
healthcare costs while promoting effective, high quality medical care. They include:
This coordinated approach helps reduce hospital admissions, decrease emergency room visits and helps prevent expensive surgeries down the road.
Our Patient-Focused goals include:
Coordinated care helps get people healthier at less cost. For Wyoming patients, Patient-Focused Care could be just what the doctor ordered!
Use this form to let us know if your practice offers telemedicine services.
Use this form to file an adjustment or report an over payment to a professional claim.
Use this form to file an adjustment or report an over payment to an institutional claim.
This form is used to request transfer of authorization from a previous insurance carrier to BCBSWY.
Use this form to file an appeal for a BlueCard claim.
This form is used to verify the health care coverage of your patients and to assist you in determining primary and secondary coverage.
Use this form to update provider or office contact information with BCBSWY.
This form may be used by a health care provider to notify BCBSWY of a patient’s intent to receive services requiring prior certification.
Use this form to submit a voluntary refund request for dates of service January 1, 2019 and prior.
This form is used to request a price negotiation as outlined under No Surprises Act.
This form contains important information about your dental health care provider’s status.
Verify elgibility and benefits, submit claims, and more.
Access the WyoBlue Advantage provider portal, find WyoBlue information, news, and more.
Providers may request appeals for Prior Authorization Requests and Concurrent Reviews which have been denied. The specific appeals process may vary from that outlined below depending on a Member’s specific benefit plan and state and/or federal regulations.
An appeal can be submitted by a member, provider or facility. Appeals can be submitted up to 180 days from the date of the denial notice from BCBSWY.
Appeals should be submitted in writing. BCBSWY does not require any specific forms to be utilized for submission.
Appeals should include the following components to help with timely determinations:
Helpful Hint: Include claim numbers, authorization numbers and other member issue identifiers.
Once BCBSWY receives an appeal request, the appeal documentation is reviewed by medical review staff. Upon determination, BCBSWY will provide written notification to you and the member.
If you are unsatisfied with the determination of your appeal, please call Member Services at 1-800-442-2376 for further assistance.
Appeals should be sent to BCBSWY by mail or fax.
Mail:
Member Services
Blue Cross Blue Shield of Wyoming
PO Box 2266
Cheyenne, WY 82003-2266
Fax:
307-432-2942
Peer to peer conversations are discussions between a physician and a BCBSWY Medical Director regarding denied services. BCBSWY offers Peer to peer conversations for prior authorization requests denied for not demonstrating medical necessity or deemed investigational. Benefit denials are not eligible for a Peer to Peer Conversation.
A Peer to Peer Conversation may be requested by a physician’s representatives who has access to the following information.
The representative will also be asked to confirm that the physician has reviewed the BCBSWY denial documentation including any applicable Medical Policies.
The physician who rendered or requested denied services must participate in the peer to peer conversation. If the physician is unavailable for a conversation, a colleague may be allowed on a case by case basis.
Peer to peer conversations may be requested up to ten calendar days from the date of the denial notice from BCBSWY. BCBSWY may accept peer to peer conversations past ten calendar days on a case by case basis.
To schedule a peer to peer conversation, please call Provider Support at 888-359-6592. A representative will take your information, and our Medical Review Department will review the request. A BCBSWY representative will contact you to provide an update on the request.
Complete a Professional or Institutional Claim Adjustment Request Form.
The following requests require medical documentation needs to be uploaded through Availity:
If you are unable to upload supporting documentation through Availity, please reach out to Provider Services at 1-800-442-2276.
The remaining requests on the Claims Adjustment Form do not require medical documentation and should not be submitted through Availity:
The following additional information is needed to ensure timely processing:
Send written request to:
BCBSWY
PO Box 2266
Cheyenne, WY 82003
Fax requests to: (307) 432-2942
Coordination of benefits can be a complicated issue and is one of the top reasons for overpayments to providers. In order to assist you with determining primary and secondary coverage, we have listed some general guidelines for you to follow. Should you have questions regarding coverage, contact the plan who issued the coverage prior to filing a claim for services.
The first of the following rules that describes which plan pays as primary is the rule to use
The plan that covers the person other than as a dependent, for example as an employee, member, subscriber, or retiree is primary. The plan that covers the person as a dependent is secondary.
The primary plan is the plan of the parent whose birthday is earlier in the year if:
If you have any questions regarding coordination of benefits for a Blue Cross Blue Shield of Wyoming member, please contact our Member Services department at 1-800-442-2376
