CommercialReimbursementMedium impact
Reimbursement & Directory Validation Update
Blue Cross Blue Shield of Wyoming·WY · Rheumatology, Gastroenterology, Dermatology·Pharmacy
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
Effective October 1, BCBSWY will change reimbursement for infliximab (J-1745) from NDC-level pricing to J-code level pricing at the biosimilar rate. Additionally, providers must validate their directory information in Availity every 90 days to comply with No Surprises Act requirements.
Action Required
By October 1: Billing team must update expectations for J-1745 (infliximab) reimbursement as it will now be paid at biosimilar rates using J-code level pricing instead of NDC-level pricing. Every 90 days: Access Availity, select 'Manage My Organization' under user account to validate and update NPI and tax ID combinations to maintain compliance with No Surprises Act provider directory requirements.