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Serving Wyoming Medicaid Providers

 

 

Enroll/Re-Enrollment Information

Getting Started

WHY ARE MEDICAID PROVIDERS REQUIRED TO RE-ENROLL?

The Affordable Care Act (ACA) requires that all Medicaid providers be screened and re-enroll at least every five (5) years.  The federal regulations specific to provider screening and re-enrollment may be viewed at

http://www.gpo.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf

APPLICATION FEE FOR INSTITUTIONAL PROVIDERS

  • The application fee or verification of payment must be included with the provider's re-enrollment documents, i.e. provider agreement, licensure, etc.
    • Make checks payable to the Division of Healthcare Financing
    • If the fee is required and not enclosed the enrollment will be denied and the provider may be termed.
    • If the check is returned due to non-sufficient funds the provider will be terminated . 
    • Per the ACA the amount of this fee will be adjusted by the percentage change in the consumer price index for all urban customers.
    • The ACA may increase this fee each year based on the consumer price index for all urban customers.
    • Application fee is nonrefundable

APPLICATION FEE
Fee $586.00 for 2019
Fee $569.00 for 2018

  • The application fee applies to:
    • All new providers enrolling for the first time
    • All new locations
    • All re-enrollments
      • Re-enrolling due to 5 year requirement
      • Re-enrolling due to providers that become inactive

Medicaid Defined Institutional Providers

  • In-state Only
    • PRTF's, SATC Wyoming Medicaid Only Nursing Facilities, CMHCs, Clinical Medical Laboratories, and Wyoming Medicaid Only Home Health Agencies.
  • Out of State
    • Providers that are enrolled in Medicare, Medicaid (other states) and CHIP are only required to pay one (1) enrollment fee.  Verification of this payment must be included with enrollment application.

Note: The current year application fee is payable when one of these actions takes place, which may be less frequent than the 5 years.

  • Changes in ownership, tax ID, and NPI
  • Becoming inactive due to not billing within one year.

WILL I BE NOTIFIED WHEN RE-ENROLLMENT IS REQUIRED?

 Yes, as providers complete an enrollment, Medicaid will retain all the necessary dates (licensure, re-enrollment, etc.) and generate re-enrollment notifications to be mailed 60-days prior to the provider's enrollment expiration dates.

  • Do not delay in completing the re-enrollment process as failure to comply will result in termination of your Wyoming Medicaid provider number and no payments will be made.

  • If re-enrollment is "in process" but not yet "approved" by the certification date, the provider enrollment status will be made inactive.

    • Providers may begin submitting re-enrollment ANYTIME

Re-enrollment must be completed via the Medicaid Web Portal

 

HOW AND WHERE DO PROVIDERS RE-ENROLL ONLINE?

For providers who are required to re-enroll online, you may enroll at any time.

Listed below are tutorials that will guide you through the steps on enrolling/re-enrolling for each specific type on enrollment.

Group Provider Enrollment Tutorial
Individual/Pay-to-/Facility Provider Enrollment Tutorial
Treating Provider Enrollment Tutorial

Once you complete the online application process, print and sign the appropriate documents (using blue ink) and submit supporting documentation as required by mailing to:

Wyoming Medicaid
Attn: Enrollment
PO Box 667
Cheyenne, WY 82003

Make sure the following is done to avoid a denial or termination:

Legal documents must be

  • Signatures are in blue ink
    • copies and electronic signatures are NOT allowed
  • Double sided printing is not allowed
  • Must mail ALL pages of the agreement and other documents
  • Check if application fee applies
  • If needing a retro effective date, also send in an appeal letter.  See the section below for specific appealing criteria.


APPEALING ENROLLMENT BEGIN DATES

Due to the screening requirements of enrollments, backdating enrollments must be handled through an appeal process. If the provider is requesting an effective date prior to the completion of the enrollment, a letter of appeal must be submitted with proof of enrollment with Medicare or another State's Medicaid that covers the requested date to present.  You may submit the letter of appeal with the enrollment supplemental documents.

  • New enrollment /New location

    • When enrolling as new provider or new location the provider must be actively enrolled in another states Medicaid or Medicare in order to be considered for a retro effective date.

  • Re-enrollment

    • When re-enrolling and there is a gap in coverage dates that you would like removed, an appeal must be submitted in order to back date and proof of an active enrollment in another states Medicaid or Medicare must be provided.

      Example: 
Active: 2/1/2019 - Current
Inactive: 1/1/19 - 1/31/19
Active: 1/1/15 - 12/31/18

WHAT CHANGES CAUSE PROVIDER TO  RE-ENROLL BEFORE THE 5 YEARS?

  • Changes on ownership, tax ID and NPI

  • Becoming inactive due to not billing within one year

 

WHAT IS THE SCREENING PROCESS WHEN ENROLLING/RE-ENROLLING?

  • When Medicare certification is required to enroll with Wyoming Medicaid, we will rely on Medicaid/PECOS to complete the screening requirements

  • Date of birth and social security numbers (SSNs) of owners, managing employees, etc. will be screened.

  • Verification of licensure /certification and documenting current license limitations

  • Original signatures and dates on re-enrollment documents/agreements are verified and must be signed in blue ink to authenticate

  • Fingerprint based criminal background checks will be required for high risk taxonomies.

    • Home Health - 251E00000X: Durable Medical Equipment and Medical Supplies - 332B00000X; and Prosthetic/Orthotic Supplier - 335E00000X

FCBC Bulletin

Enrollment High Risk Letter

 

Frequently Asked Questions

The enrollment is considered a legal document, so the Provider Relations call center representatives will not be able to tell you how to answer the questions.  It will be up to the individual completing the application to read the enrollment questions carefully and answer the questions appropriately.  Refer to the Frequently Asked Questions for helpful tips on completing the enroll/re-enrollment process.

DO I HAVE TO COMPLETE A NEW W-9

All new pay-to providers have to complete a W-9 Form and provider banking information (void check or bank letter).  Medicaid requires ALL providers be set to receive electronic payments prior to becoming active.

When to complete W9 Form:
When there has been a change in any of the following :

  • Tax ID

  • Banking

  • Address

  • Tax classification

  • Name

NOTE: If re-enrolling and not sure if any of the above has changed, it is advised to complete a new form and your information will be updated appropriately.

Requirements for completing the W-9 Form

  • Must complete most current versions of the forms

    • Line 1 on the W9 is for the legal name associated with the EIN/SSN with the IRS. If unsure what your legal name is, please contact the IRS prior to completing your forms.

    • Line 2 is for the Doing Business as (DBA) if there is one.

      • If the DBA is the same as the legal, leave line 2 blank

    • Signature requirements:

      • Must be orginal signature

        • The signature can be a copy BUT stamp and electronic signatures are not allowed.

  • Voided check must be original OR

  • Bank letter must contain ALL of the following:

    • On bank letterhead

    • Dated no older than 1 year

    • Name associated with the account

    • Account and routing number

    • Account type (checking or savings)

    • MUST have original signature of bank representative

  • Documents must be legible.

CONTACTS / RESOURCES

For questions or assistance regarding the re-enrollment process, contact Provider Relations at 1-800-251-1268.

Choose Option 2, Option 1, and Option 2 to speak with an agent.

 

Group Provider Enrollment Tutorial
Individual Pay-to/Facility Provider Enrollment Tutorial
Treating Provider Enrollment Tutorial