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CommercialPrior AuthHigh impact

Online Prior Authorization Webinar

Blue Cross Blue Shield of Wyoming·WY · ENT (Ear, Nose & Throat), Ophthalmology·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 19, 2026
Days to comply

Summary

BCBSWY requires prior authorization for all hearing aid services effective 01/01/2024, with automatic denials for services without prior auth. Prior authorization requirements have been removed for Iron Sucrose (J1756) and Ocular Angiogenesis products (J0178) as of 11/6/23, and emergency protocol medications do not require prior authorization.

Action Required

Action needed
Immediately: Update billing system to require prior authorization for ALL hearing aid services and related HCPCS codes for FEP members. Remove prior authorization requirements from Iron Sucrose (J1756) and Ocular Angiogenesis products (J0178) for dates of service 11/6/23 and later. Contact Provider Relations for any J1756 or J0178 claims denied after 11/6/23. Do NOT submit corrected claims with remark code M63 through Availity - use adjustment forms via mail or fax only. Emergency protocol medications (J1720, J1200, J1642, J2175, J2997, J0171, J2469, J0640) do not require prior authorization.

Affected Billing Codes

J1756
J0178
J1720
J1200
J1642
J2175
J2997
J0171
J2469
J0640