Dental

HIPAA 5010

Serving Wyoming Medicaid Providers

COVID-19 INFORMATION

Please see below to learn about the Wyoming Medicaid response to COVID-19 and find the latest program guidance.

Additional information will be added as it becomes available.

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PASRR Requirement for NH & Swing Bed Providers  

Telehealth Changes to COVID-19 

Billing Information  

Enrollment/Re-Enrollment Exception

Resources UPDATED

PASRR Requirements for NH & Swing Bed Providers

In an effort to eliminate any barriers to care that might exist in relation to the COVID-19 virus, Wyoming Medicaid is temporarily suspending the requirement for PASRR Level I and PASRR Level II for thirty (30) days.  All new admissions may be treated like exempted hospital discharges.  After 30 days, new admissions with mental illness or intellectual disability should receive a PASRR Level I and PASRR Level II, if required. 

For the safety of the clients and staff, the PASRR Level II can be conducted remotely by telehealth or telephonically.  Please make sure the individual remains directly involved in the evaluation process to the fullest extent.

See the below bulletins for additional information
Additional updates to Nursing Home and Swing Bed PASRR Requirements 4.8.20 
REVISED Nursing Facilities COVID-19 PASRR 3.31.20
Nursing Facility COVID-19 PASRR Changes 3.27.20

Telehealth Changes for COVID-19

Any services that are clinically appropriate may be billed via Telehealth.  Be sure to mark the emergency indicator for any COVID-19 services.

The GT Modifier is not an allowed outpatient modifier for claims processing through OPPS.  Refer to Section 11.16.10 Modifiers, within the Institutional/UB Provider Manual for more information.

For additional information and billing instructions refer to Chapter 6 Section 24 (Telehealth 6.24).

Additional Resources
AAP Guidance  
AAFP Guidance

Billing Information

Codes

• U07.1 - COVID-19 DX code: valid for dates of service beginning 4/1/2020.
• 87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus Disease [COVID-19]), amplified probe technique: valid for dates of service beginning 3/13/2020.
• U0001 - CDC 2019-Novel Coronavirus Real-Time RT-PCR diagnostic panel: Valid for dates of service beginning 2/4/2020.
• U0002 - Non CDC Laboratory tests for COVID-19:valid dates of service beginning 2/4/2020.
• U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput probe technologies as described by CMS-2020-01-R
• U0004 - 2019-n-CoV Coronavirus, SARs-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R
• U0005 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome conornaviruse.  An add-on reimbursement to U0003 and U0004 and should only be billed if the test result is:
  • Returned within 2 calendar days of the specimen being collected, and
  • A majority of the laboratory's high throughput tests in the previous calendar month were completed within 2 calendar days from specimen collection 
• A0998 - Treat and Release: valid for Ambulance taxonomies for the duration of National and State Public Health Emergency declarations.
• 99600 - Home visit NOS: valid for Ambulance taxonomies for the duration of National and State Public Health Emergency declarations.
• G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS - CoV-2) (Coronavirus disease [COVID-19]), any specimen source
• G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS - CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
• 99000 - Handling and/or conveyance of specimen for transfer from the office to a laboratory. This code is now open to all provider types.
• 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
• 91301- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use
• 90471- Immunization Administration; 1 Vaccine (Single or combination vaccine/toxoid)
• 90472- Immunization Administration; Each additional vaccine. To be listed separately in addition to code for primary procedure.
• 0001A - Pfizer-Biontech COVID-19 Vaccine Administration - First Dose
• 0002A - Pfizer-Biontech COVID-19 Vaccine Administration - Second Dose
• 0011A - Moderna COVID-19 Vaccine Administration - First Dose
• 0012A - Moderna COVID-19 Vaccine Administration - Second Dose
• 0021A - AstraZeneca COVID-19 Vaccine Administration - First Dose
• 0022A - AstraZeneca COVID-19 Vaccine Administration - Second Dose
• 0031A - Janssen COVID-19 Vaccine Administration

Policy Exceptions

• Ambulance covered services will be extended to transportation of a patient, regardless of their COVID-19 status, to a location other than the most appropriate or closest hospital in order to prevent overloading of a hospital or due to excess patient census.

Prior Authorization Changes

• Rental Ventilator PA Requirement will be suspended for dates of service beginning 3.1.20. Codes effected:
  • E0466
  • E0470
  • E0471
  • E0472
  • E0481
• Home Health PA requirement suspended effective 3/17/2020 - 11/30/2020.  Per the Home Health and DME Prior Authorization Requirement Reinstatement bulletin below this exception ended for 12/1/2020 and forward dates of service.
• Change Healthcare has created a new electronic prior authorization submission portal for pharmacy prior authorization submission. This portal can be found under the Prescriber Information tab at http://www.wymedicaid.org/ 

See below bulletins for additional information

Home Health & DME Prior Authorization Requirement Reinstatement
COVID-19 Flier for Wyoming 4.28.20
Pharmacy Electronic PA Submission 4.4.20 
Home Health Removal of PA 3.18.20
COVID-19 Testing Codes RA Banner
COVID-19 Ambulance Changes 3.27.20

Provider Enrollment / Re-Enrollment Exceptions

Wyoming Medicaid recognizes the importance of supporting its providers and has made the following process changes, which will remain in effect through the COVID-19 emergency.  The goal of Medicaid is to make and keep providers active during this hectic time to allow providers and their offices to focus on providing services to Wyoming residents.

Medicaid's initiative requiring all current active providers to receive electronic bank transfers (EFT) by April 1, 2020 is still a mandate but providers will remain active if they do not meet the date.

Medicaid is diligently working on making the necessary updates to the provider files impacted by the COVID-19 exceptions outlined below.  We anticipate in having all the files updated no later than 4/6/2020, at that time providers may resubmit any denied claims meeting the criteria.

1. Medicaid will be updating inactive providers to active, if they became inactive between the dates of 1/1/2020 to current for one of the following reasons:
   • Provider failed to provide Medicaid with their current Medicare certification (inactive status of B)
   • Provider failed to provide Medicaid with their current license or certification (inactive status of D)
   • Provider has not had any paid or denied claims within the last 15 months (inactive status of J)
2. CLIA Licenses with the end date from 1/1/2020 to 9/30/2020 will have their end dates extended to avoid claim denials.
   • Letters will still be mailed and providers are encouraged to email their updated licenses when they are able
3. Enrollment and & Re-enrollment temporary policy changes
   • Any provider that became inactive due to not completing the re-enrollment application between the dates of 1/1/2020 to current will be made active
   • Re-enrollment letters will continue to be mailed but providers will remain in an active enrollment status and will not be terminated
   • Enrollment/Re-enrollment supporting documentation changes
     • Copies/scanned images/faxes/emails/electronic signatures for the following documents will be accepted at this time:
   • Provider Enrollment Certification
   • Healthcare Provider Agreement (blue ink requirement is temporarily waived)

EFT remains a requirement for all new enrolling providers.  To protect providers/vendors the State Auditor's Office (SAO) requirements for electronic funds transfer (EFT) remain the same:

• W9 Form - copy is accepted, but must have an original signature, electronic signatures are not accepted.
• EFT requires one (1) of the following:
  • A voided check
  • Original bank letter
• Visit the SAO website for the W9 Form and any additional questions, https://sao.wyo.gov/vendors/

Medicaid Provider Enrollment email address is wyenrollment@conduent.com

Resources

Wyoming Department of Health EUR Webinar NEW
Cares Act Funding for Mental Health and Substance Abuse Services
CMS New Nursing Home Resource Center
AAP Critical Updates 
AAP Telehealth Guidance 
CDC Recommended Child & Adolescent Immunization Schedule
AAFP Telehealth Guidance
CDC Vaccine Storage & Handling Toolkit
CMS Information and Guidance Medicaid Postcard
Wyoming Medicaid 1135 Waiver Approval Letter

CMS Lessons from the Front Lines: COVID-19

On behalf of CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD and the White House Coronavirus Task Force, we invite you to join CMS Lessons from the Front Line: COVID-19 on Friday, April 17th from 12:30 - 2 PM EST. This call series is an opportunity to hear physicians and other clinical leaders share their experience, best practices, strategies, and insights related to COVID-19.

Lessons from the Front Lines calls are held weekly on Fridays at 12:30 PM Eastern and specific topics vary.  Dial in details are below

CMS Dial in (877) 251-0301

Access Code: 8672948

Webcast Streaming: https://protect2.fireeye.com/url?k=6fb83c6b-33ed3578-6fb80d54-0cc47adb5650-cdbb9430fa7bc190&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1924

 Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser.

The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund (PRF), is distributing $15 billion to eligible Medicaid, CHIP, and Dental providers.  if you are a provider who is interested in learning about the application process for the PRF, please register and join the webcast on July 27th.  Please feel free to share the webcast information with other providers that would be interested in participating as well.

Presenting: Getting Started wiht the Provider Relief Fund for Medicaid, CHIP, and Dental providers

Date: July 27th

Time: 3-4 p.m. ET

Registration Link: https://webex.webcasts.com/starthere.jsp?ei=1348276&tp_key=fa54a9fb41

* Please pre-register to reserve a spot.  This event will be delivered via webcast, no dial in required.  Presentation materials will not be distributed.