CommercialPrior AuthHigh impact
Prior Authorization Updates
Blue Cross Blue Shield of Wyoming·WY·Prior Authorization
Effective date
Feb 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Wyoming updated pharmacy prior authorization submission processes effective 2/1/25, creating different workflows based on member ID prefixes. Members with certain prefixes use CoverMyMeds, while others require completing MyPrime forms and submitting through Availity with specific procedure codes.
Action Required
By February 1, 2025: Billing team must implement new pharmacy prior authorization workflows based on member ID prefixes. For ZSF, QWY, or ZSK prefixes: submit through CoverMyMeds. For ZRW, ZSD, ZWY, or YWY prefixes: complete MyPrime forms, submit through Availity as 'Outpatient Authorization' requests, and use J3490 for drugs without specific HCPCS codes. Update staff training and create reference guides for ID prefix identification to ensure correct submission pathways.