CommercialPrior AuthHigh impact
Enhancing Provider Support During Open Enrollment
Blue Cross Blue Shield of Wyoming·WY · Orthopedics, Neurosurgery·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Starting January 1, 2026, Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Standard or Basic Option plans will require prior authorization for all hip, knee, and spine surgeries. Blue Cross Blue Shield Wyoming has also expanded their provider service team during open enrollment to handle increased call volumes.
Action Required
Before January 1, 2026: Billing team must update system to require prior authorization for all listed hip, knee, and spine surgery codes for FEHB and PSHB Standard/Basic Option plan members. Update encounter forms and EMR templates to alert providers that prior auth is required. Monitor for the official FEP medical policy when it becomes available. Claims submitted without proper prior authorization will be denied.