Rx Authorizations
For BCBSWY member ID numbers beginning with…
| Code | Authorization Form |
| Go to Form |
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Site Section: Providers
Billing & Claims
Looking for WyoBlue Advantage billing and claims information?
Visit the WyoBlue Advantage Providers page by clicking the link below.
| Upload Transaction Files through Availity | Instructions for how to upload an EDI batch file | Download Form |
| Professional Claim Adjustment Form | Use this form to file a professional claim adjustment. | Download Form |
| Institutional Claim Adjustment Form | Use this form to file an institutional claim adjustment. | Download Form |
| Claim Remark Codes | View Remittance Advice Remark Codes. | View Codes |
| Instructions for CMS 1500 Form | Instruction manual detailing how to complete the CMS 1500 Form. | Read More |
| Electronic Claim Correction Instructions | Instructions detailing electronically processed claims corrections. | Read More |
| Obesity Coverage Guidelines | Guidelines for the full Obesity Benefit Synopsis. | Read More |
| Behavioral Health Guidelines | Guidelines to ensure timely and accurate payments for mental health and substance abuse programs. | Read More |
| Hospice Billing Guidelines | Guidelines to ensure more timely and accurate processing of hospice claims. | Download Guide |
| Telemedicine Matrix | Keep updated on Telemedicine Services. | Read More |
| Bright Futures Guidelines | BCBSWY covers the Bright Futures recommendations for pediatric screenings. | Read More |
| A1C Code Information | Keep updated on A1C coding information. | Download Guide |
| Home Infusion Therapy Guidelines | Guidelines to ensure more timely and accurate processing of HIT claims | Download Guide |
| Preventive and Medical Billing Guidelines | Billing and Claims Guidelines for Preventive and Medical Office Visits | Download Guide |
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Provider Resources
Learn How it Works
How to Upload Attachments to Availity
View our Online Medical Document Attachment Training Guide.
How to Submit a Online Prior Authorization Request
View our Prior Authorization Online Training Guide.
Electronic Funds (EFT) Requests
Providers set up for electronic remits can receive EFT payments. Use Availity to enroll or make changes to an EFT account.
Out of Area Search
Medical Policy Information
To find medical policies or general precertification/preauthorization information for out of area members:
- Select Medical Policy or Precertification/Preauthorization.
- Enter the first three characters (Prefix) of the ID number located on the patient's ID card.
Select one:
If you experience difficulties or need additional information, call 800.676.BLUE.
Provider Resources
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Updates to 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 through 8/31/20. 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.
- Go to www.fepblue.org/telehealth for more information on FEP telehealth benefits.
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.
RX Services
BCBSWY encourages members to explore mail-order options for your prescription refill needs.
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 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.
Request Participating Provider Application
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.
Contact Provider Services
- Patient Billing, Benefits or Claims
1-888-359-6592 - Provider Network Participation
1-888-666-5188 - Pre-Admission Review
1-800-251-1814 - Case Management
1-800-442-2376 - Blue Card® Claims Status
1-888-359-6592 - Mail
Blue Cross Blue Shield of Wyoming
P.O. Box 2266
Cheyenne, WY 82003 - Fax 307-634-5742
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Contact Us
Provider Questions, Answered.
You’re in the right place.
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.
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WyoBlue Advantage
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Provider Resources
Contact Provider Services
Patient Billing, Benefits or Claims
1-888-359-6592
Provider Network Participation
1-888-666-5188
1-800-251-1814
1-800-442-2376
1-888-359-6592
Blue Cross Blue Shield of Wyoming
P.O. Box 2266
Cheyenne, WY 82003
Fax
307-634-5742
Find additional contacts and more information in our Provider Manual.
Tell BCBSWY About Your Experience
We are always interested in your feedback and how we can serve you better.
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A Word from BCBSWY CMO Joseph Horam M.D.
COVID-19 Testing
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.
- PCR molecular testing has high specificity and sensitivity as the standard for diagnostic detection of COVID-19. Cost share is completely covered.
- Antigen testing identifies viral nucleocapsid protein that has a recent CLIA certificate of waiver for point of care diagnostic screening. Lower sensitivity results may require a reflex to PCR testing.
- Antibody serology testing for antibody detection is best applied to public health surveillance for understanding community prevalence. Limitations of antibody testing include unproven efficacy for immunity determination. Over 100 serology tests have been marketed, however only 8 have met FDA approval by the emergency use authorization (EUA) requirements for data submission. Antibody testing is not an independent diagnostic test as it takes 1-2 weeks after the onset of illness to generate initial IgM followed later with IgG results. Antibody testing for diagnostic purposes is limited. Benefits do not apply to surveillance, return to work or asymptomatic screening.
- Respiratory Panels include 22 pathogens and many include COVID-19. The decision to perform a respiratory panel should be individualized and not routinely utilized.
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.
COVID-19 Antibody Billing Guidance
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.
COVID-19 – Billing Guidance
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.
BCBSWY COVID-19 Response
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:
- Guidance on COVID-19 specimen collection laboratories billing
- Guidance on hospital to skilled nursing facility transfers
- Telemedicine matrix for billing services
- Telemedicine FAQ
Stay Informed!
- Get email updates! Ask to be added to receive Provider Updates at [email protected]
For more information see: CDC COVID-19 or State of Wyoming COVID-19
Dental Guideline
Questions? This guideline details what you need to know.
General Dental FAQ
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.
FEP FAQ
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].
New provider portal routine dental.
Dental Provider Portal
Submit medical dental claims online.
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WyoBlue Advantage
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Provider Resources
United Concordia is an independent company providing administrative services for Blue Cross Blue Shield of Wyoming members and providers.
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Partnership Programs
Working together for better health care
Patient-Focused 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:
- Rewarding doctors for keeping you healthy.
- Focusing on prevention, wellness and care coordination.
- Encouraging care at the right location to help lower healthcare costs.
- Using better data to help doctors and patients understand health concerns.
This coordinated approach helps reduce hospital admissions, decrease emergency room visits and helps prevent expensive surgeries down the road.
Our Patient-Focused goals include:
- Improving the way doctors and hospitals are paid.
- Giving doctors and hospitals the tools and data they need.
- Encouraging people to be active partners in their own healthcare.
- Reining in costs for everyone.
Coordinated care helps get people healthier at less cost. For Wyoming patients, Patient-Focused Care could be just what the doctor ordered!
