CommercialBilling CodesMedium impact
Advanced Claim Editing, Document Processing, Authorization Pre-Check & More
Blue Cross Blue Shield of Wyoming·WY · Family Medicine, Pediatrics, Cardiology +1 more·Prior Authorization
Effective date
Mar 1, 2023
We identified it
Jun 19, 2026
Summary
BCBS Wyoming has updated their automated claim editing rules with specific frequency limits for pediatric preventive visits and new requirements for ECG billing. The policy also provides guidance on using PDF format for prior authorizations and highlights available pre-check tools.
Action Required
By March 2023: Billing team must update system rules to limit pediatric preventive visits - no more than 8 visits per year for patients under 1 (codes 99381/99391), and no more than 7 visits in 4 years for patients 1-4 years old (codes 99382/99392). Also update billing software to require CPT 93005 when billing 93010 with office E/M visits. Convert all prior authorization documents to PDF format. Train staff on Authorization Pre-Check tool on Availity.com to verify prior auth requirements.