A Prior Authorization Service Request is the process of notifying BCBSWY of information about a medical service to
establish medical appropriateness and necessity of services. The following information describes the general policies of Blue Cross Blue Shield of Wyoming and is provided for reference only. Pre-admission or prior authorization requests for health care services are NOT A GUARANTEE OF
PAYMENT. You can verify coverage or benefits or determine pre-admission or prior authorization request requirements for a Member by going to Availity.com. The Authorization Pre-Check tool allows you to determine if a prior authorization is required for a member upfront. Simply
enter the requested information in Availity, and you will get a yes or no answer if an authorization is required. Keep in mind, this is for BCBSWY members only. Updated Aug. 25, 2022 Subject to Medical PoliciesBCBSWY recommends authorizing procedure codes associated with BCBSWY medical policies if the medical policy criteria is not met. CPT codes subject to medical policy may deny for the following reasons if medical policy criteria are not met and an authorization is not on file: a.) deny for no authorization b.) deny for not medically necessary c.) deny experimental/investigational d.) deny for records Updated Aug. 25, 2022 Special Circumstances for Gender Reassignment of Prophylactic ServicesAuthorization may be required when related to Gender Reassignment or Prophylactic (when the group does not have outright coverage) services. Benefits will be denied if the patient is not eligible for coverage under the benefit plan on the date services are provided or if services received are not medically appropriate and necessary. Inclusion of a service on this guideline does not guarantee payment. Visit the Authorization Pre-Check tool at Availity.com. Complete a Prior Authorization RequestFor services which require BCBSWY prior authorization, login to Availity. The Authorization Tool is found under Patient Registration. You can also complete a Prior Authorization Request Form and submit it as instructed. Medical records will be required with each submission. Please only mark a prior authorization request URGENT* if failure to receive treatment will result in a life or limb threatening situation. Non-urgent requests marked urgent will delay processing. BCBSWY does not recognize scheduling conflicts as an urgent request. Processing a Prior Authorization RequestWhen BCBSWY receives a prior authorization request from a Provider, it will be reviewed by our clinical staff. BCBSWY’s Medical Policies are used in this review. These policies are available online for providers and are searchable by title, CPT code and identification number. A determination (approved or denied) will be rendered from the information submitted:
*For further explanation of
the urgent prospective review criteria, please visit the Checking StatusYou can use the Availity authorization dashboard to see the status of all authorizations in your organization. Contact UsYou can also contact BCBSWY Member Services at 800-442-2376 if a determination has not been received within the timeframes shown above. Ready to join our network?Does BCBS of Michigan require prior authorization?BCBSM requires prior authorization for services or procedures that may be experimental, not always medically necessary, or over utilized. Providers must submit clinical documentation in writing explaining why the proposed procedure or service is medically necessary.
How do I submit a prior authorization to availity?How to access and use Availity Authorizations:. Log in to Availity.. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations*. Select Payer BCBSOK, then choose your organization.. Select a Request Type and start request.. Review and submit your request.. Is BCBS of Illinois Medicaid?The Centers for Medicare & Medicaid Services (CMS) and the State of Illinois have contracted with Blue Cross and Blue Shield of Illinois (BCBSIL) along with other Managed Care Organizations (MCO) to implement Medicaid to all counties in Illinois.
How do I contact Blue Cross Blue Shield of Illinois?How to Contact Us. Member Services. 1-877-860-2837 (TTY/TDD: 711) Call to ask about your plan benefits, help finding a provider, to change your PCP, and much more. ... . 24/7 Nurseline. 1-888-343-2697 (TTY/TDD: 711) ... . By Mail. Blue Cross Community Health Plans.. |