Site of Care Exemption requests
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This document governs how health care providers submit Site of Care Exemption requests to Blue Cross Blue Shield of Wyoming on behalf of participants, including required documentation, submission methods, and urgency criteria.
No material clinical or coverage changes in this revision.
Clinical Justification and Criteria
Clinical justification questions
Provider should document specific clinical reasons for requesting a Site of Care Exemption. The form includes targeted clinical questions to support why a higher level of care is clinically necessary.
ALL of the following
- Does the member have a documented history of a comorbidity that is of significant concern in relation to the drug requested?
- Does the member have any concerns of fluid overload status that precludes treatment at a less intensive site of care?
- Is there any continuity of care issue that would preclude the member from changing to another site of care?
- Is this medication part of a multiple medication treatment regimen?
Codes and Urgency Qualification
| Procedure Code(s)(CPT) | Place to list CPT procedure codes related to requested treatment |
| Diagnosis Codes (ICD10) | Place to list ICD-10 diagnosis codes related to requested treatment |
How to Submit and Handle Requests
Submit exemption request
Submit a completed Site of Care Exemption request form in writing and attach clinical documentation of need; incomplete forms or missing clinical documentation will delay processing and will not be considered until all information has been received.
- Send request on the participant's behalf in writing to BCBSWY.
- Attach all required clinical documentation to the form.
Urgent request criteria
Mark requests as URGENT only when failure to receive treatment would result in a life- or limb‑threatening situation; requests that do not meet this criterion (including scheduling conflicts) will be treated as non‑urgent and may be delayed.
- BCBSWY does not recognize scheduling conflicts as urgent.
- Authorizations not meeting urgent criteria will be processed as non‑urgent.
Privacy and confidentiality
Protect patient privacy when emailing requests: send email only if you can do so securely and include the provided confidentiality notice guidance for misdirected communications.
- Email Site of Care Services at redirectionofcare@bcbswy.com only via secure email methods.
- Follow the confidentiality notice instructions if you receive the message in error (call 1.800.442.2376 or fax 307.634.5742).
Key Definitions
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