Wyoming

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Serving Wyoming Medicaid Providers

 

 

Institutional / UB Manual and Bulletins

 

Institutional/UB Manuals

Institutional Provider Manual (Effective 4.1.20)

iExchange Registration Reminder RA Banner

WYhealth iExchange Registration 4.29.20

Optum Bulletin - PA Vendor Transition April 2020

Additional updates to Nursing Home and Swing Bed PASRR Requirements 4.8.20

Home Health COVID-19 Telehealth 4.1.20

Prior Authorization Vendor Transition 4.2.20

Revised Nursing Facilities COVID-19 PASRR 3.31.20

Nursing Facilities COVID-19 PASRR Changes 3.27.20

New WY Medicaid Pregnacy Care Reporting Code 3.23.20

FQHC/RHC Tribal Facilities Telehealth 3.20.20

BH Peer Specialist via Telehealth 3.20.20

BH Group Therapy via Telehealth 3.18.20 

COVID-19 Testing Codes RA Banner3.19.20

LARC Billing and Reimbursement 2.12.20

Medicare Crossover Policy Change 1.30.20

New Behavioral Health Modifier Requirement 1.30.20

Updated Policy Enteral Nutrition and Incontinence Products 1.21.20

WCP Dx Code Rebilling RA Banner 2.27.20

WY Medicaid COVID-19 Update Postcard 3.16.20

Tribal Provider Manual (4.1.20)

Changes to Botox, Dysport, and Myobloc Requriements

FQHC, RHC, & IHS - Tribal Clinics Billing Requirement Bulletin

FQHC, RHC IHS - Tribal Dental Billing Changes

TPL Priority Diagnosis List - This is a list of diagnosis codes that must be billed with external cause code(s).  This list includes diagnoses for burns, corrosion, abrasions, contusions, hematomas, crushing injuries, fractures, head injuries, other injuries, spinal injuries, wounds, and lacerations.

Edits EOBs and Resolutions 4.2.20
This is a list of edits that may post when verifying claims in the Secure Web Portal, along with the possible EOB codes that would post on any claim denials.  Each edit and EOB combination has a suggested resolution.


Provider Medicaid and State Health Care Benefit Plan 12.31.19
PASRR Manual
MI/MR ICD-10 Diagnosis Code List
LOC Diagnosis and Procedure Codes
APR-DRG Navigant Presentation
DRG Edits and EOBs
DRGs Requiring Prior Authorization


To search for specific information within the PDF document, select Ctrl F on your keyboard and type your keyword in the find box.

 

Title 25

 

Title 25 Claim Checklist
Provider Memo April Changes 4.1.17
Title 25 Provider Manual
WSH Cert Form 4.1.17
Title 25 State Letter

 

 

 

Important Policy Changes/Additions

Manual Updates

Institutional Provider Manual (Effective 1.1.20)
Institutional Provider Manual (Effective 10.1.19)
Institutional Provider Manual (Effective 7.1.19)
Institutional Provider Manual (Effective 4.1.19)
Institutional Provider Manual (Effective 1.1.19)
Institutional Provider Manual (Effective 10.1.18)
Institutional Provider Manual (Effective 7.1.18)
Institutional Provider Manual (Effective 4.1.18)
Institutional Provider Manual (Effective 1.1.18)
Institutional Provider Manual (Effective 10.1.17)

Tribal Provider Manual (1.1.20)
Tribal Provider Manual (10.1.19)
Tribal Provider Manual (7.1.19)

 

 

Institutional Bulletins

2020 Bulletins

iEchange Registration Reminder RA Banner
WYhealth iExchange Registration 4.29.20
Changes to Botox, Dysport, and Myobloc Requirements
Optum Bulletin - PA Vendor Transition Apr 2020
Additional updates to Nursing Home and Swing Bed PASSR Requirements 4.8.20
Home Health COVID-19 Telehealth 4.1.20
Prior Authorization Vendor Transition 4.2.20
Revised Nursing Facilities COVID-19 PASRR 3.31.20
Nursing Facilities COVID-19 PASRR Changes 3.27.20
New WY Medicaid Pregnacy Care Reporting Code
COVID-19 Testing Codes RA Banner
WY Medicaid COVID-19 Update Postcard
WCP Dx Code Rebilling RA Banner
LARC Billing and Reimbursement
New Behavioral Health Modifier Requirement
Medicare Crossover Policy Change
UPDATED Policy Enteral Nutrition and Incontinence Supplies

2019 Bulletins

RA Banner Reminder of Two Important Bulletins
Policy Change to Enteral Nutrition and Incontinence Products
Policy Change! Updated Inmunization Policy
Important Information! Change in Prior Authorization Vendors
Nursing Home and Swing Bed Providers - Billing PT, OT, and ST
Client Contact Phone Numbers RA Banner
Behavioral Health and Speech Therapy Visit Threshold Change
1099 and W9 Update
BCC and COLR Reminder When or When Not to Bill a Client RA
Pregnant by Choice Program Brochures and Posters Available 9.16.19
Outpatient Crossover Claims Update 8.19.19
ARP-DRG Update Bulletin 8.1.19
Interceptive Care Bulletin 7.25.19
Threshold FAQ 7.15.19
WY Access Monitoring Review Plan
Wyoming Medicaid APR-DRG Update
Correction - Office Visit Threshold Process
Change - Authorization of Medical Necessity
Genetic Testing PAs to Optum RA Banner
Summer 2019 Billing Workshops
Wyoming Mediciad Provider Enrollment Change
Medicare Non-Covered DME Codes
Payment Schedule Change for 3.13.2019 Due to State Closure
Urgent  - Attachment Requirements
Dental Orthodontic PA Changes - Bulletin
New Portal Feature -  PA Look Up - Bulletin
J7303 and J7340 Changes
Dental Code Changed 2019

 



 

 

Additional Links

Nursing Facility Revenue Codes: Provides a table of appropriate revenue codes for Nursing Facilities.
Medicaid and State Healthcare Benefit Plans: Provides client benefit plan names, descriptions, eligibility limitations, coverage types and coverage limitations. This information is useful when determining if a client is eligible for services.
NDC Crosswalk : Provides a listing of the drug related procedure codes requiring an NDC. The listing provides the NDC, HCPCS (J codes), HCPCS and NDC descriptions, effective dates, end dates, and if applicable for Medicare crossovers only.
Carrier Code List: List of Insurance Carrier Codes and Names


OPPS 

OPPS Fee Schedule
OPPS Bulletin 08/16/2004
OPPS Remitance Advice EOB Codes 5/06/2008



DART Chart Information

Appropriate Payer Solution DART Chart State Health Care
DART Chart appropriate Payer General Overview 7.28.14

Below find some helpful links to areas of Medicare's web pages which may help you in understanding certain edits used in the processing of OPPS priced claims using the IOCE (Integrated Outpatient Code Editor). Please be aware that while Wyoming Medicaid uses the Medicare software, there may be some differences in policy and implementation of any given rule or guideline. Please contact Provider Relations at 800-251-1268 with any questions regarding specific policy or billing questions.

Helpful Medicare Links

  • Hospital Outpatient PPS Resources related to Medicare OPPS information which may assist in understanding Wyoming Wyoming Medicaid OPPS priced claims.
  • Hospital Outpatient PPS Transmittals Quarterly updates to OCE software for OPPS modifications. By searching on quarterly transmittals, Appendix M Summary of Modifications resources can be found for: diagnosis coding changes, status indicator changes, HCPCs changes, and composite APCs. ***Please note that the transmittal is not always a direct crosswalk to WY Medicaid; it is a reflection of CMS Manual Changes and Wyoming might choose to modify certain aspects.
  • NCCI Edits - Hospital Outpatient PPS This page will allow review of mutually exclusive and incompatible code combinations.
  • Device, Radiolabeled Product, and Procedure Edits Resources related to procedure/device combinations, including information regarding edits, combinations of codes and other information.