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Serving Wyoming Medicaid Providers

 

 

CMS Re-Enrollment Requirement

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. However, if you need someone to walk you through the enrollment/re-enrollment, please contact the call center to set up a time between 8AM and 9AM where someone can contact you to help you with the enrollment process. 

If you only have one or two questions, please contact the call center during normal business hours 9AM – 5PM MST.

The Provider Relations call center phone number is 800-251-1268. Choose Option 2, Option 1, Option 2 to speak with an agent.

When completing the ownership section, read the Ownership Section carefully. The section must be completed for each person who has ownership, control interest, is an officer, director, partner, agent, or managing employee in the entity specified in the enrollment.

Consider the type of entity that is being enrolled when completing the section. How is the business set up? Is the business/facility an individual practice, corporation or nonprofit corporation, government entity, partnership, trust, or sole proprietor? The answer to this will help determine the information needed within the Ownership Section.

Frequently Asked Questions

TIMELINE

ON-LINE / WEB RE-ENROLLMENT STARTS:
MAY 1,  2014

All Re-Enrollment Certification Must BE Completed by:
December 31, 2015

 

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 screenings and re-enrollment may be viewed at:
http://www.gpo.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf

DO I RE-ENROLL ONLINE OR VIA PAPER APPLICATION?

Providers that are required to re-enroll via paper application can obtain an updated paper enrollment application by requesting one from Provider Relations (800) 251-1268 and choose Option1, followed by Option 5, followed by Option 0. Paper Applications will only be accepted for those providers who are not required to re-enroll online.

To complete the paper re-enrollment Providers will need their current Medicaid provider number (not your NPI)

  • Providers can locate their Medicaid provider number at the header section (first line) on a remittance advice (RA). The provider's Medicaid number is the first number following, "PROVIDER NUMBER:" on the RA
  • Additional information to help you interpret the information listed on your remittance advice may be found in Chapter 6 of the CMS-1500, Dental or Institutional Provider Manuals
  • Complete the on-line application process, print and sign appropriate documents (using blue ink), and submit supporting documentation as required

HOW AND WHERE DO PROVIDERS RE-ENROLL ONLINE?

For providers who are required to re-enroll online, you may begin enrolling as of May 1, 2014

To re-enoll online follow the steps below:

  • From the navigation bar on the left, Select Provider Enrollment
  • Select Online Enrollment
  • Enter Email Address and click on Create
  • Keep your reference number in case you need to return to your enrollment application
  • Answer the first question "Is this enrollment a re-enrollment?" as YES if you are re-enrolling
  • Enter your Wyoming Medicaid provider number (not your NPI)
    • Providers can locate their Medicaid provider number at the header section (first line) on a remittance advice (RA). The provider's Medicaid number is the first number following, "PROVIDER NUMBER:" on the RA
    • Additional information to help you interpret the information listed on your remittance advice may be found in Chapter 6 of the CMS-1500, Dental or Institutional Provider Manuals
  • Complete the on-line application process, print and sign appropriate documents (using blue ink), and submit supporting documentation as required

ARE THERE APPLICATION FEES?

The ACA has imposed an application fee on institutional providers.

Fee $586.00 for 2019
Fee $569.00 for 2018

Per the ACA this fee will increase each year based on the consumer price index for all urban consumers.

INSTITUTIONAL PROVIDERS REQUIRED TO PAY THE APPLICATION FEE:

  • In-state only
    • PRTFs, SACs, Wyoming Medicaid Only Nursing Facilities, CMHCs, Clinical Medical Laboratories, and Wyoming Medicaid Only Home Health Agencies (re-enrolling and newly enrolling)
  • 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.
  • The applicaton fee is required for new locations, new enrollments, for re-enrollments, and for Medicaid requested re-enrollments (i.e. inactive enrollment statuses).
    • The current year application fee is payable when one of those actions takes place, which may be less frequent than the 5 years.

APPLICATION FEE IS NON-REFUNDABLE:

  • 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 provider will be terminated or denied.
    • If the check is returned due to non-sufficient funds the provider will be terminated or denied.
    • Per the ACA the amount of this fee will be adjusted by the percentage change in the consumer price index for all urban customers.

WHAT CHANGES CAN PROVIDERS EXPECT WHEN RE-ENROLLING?

  • When Medicare certification is required to enroll with Wyoming Medicaid, We will rely on Medicare to complete the screening requirements
  • Date of birth and social security numbers (SSNs) of owners, managing employees, etc.
  • Verification of licensure and documenting current license limitations
  • The new provider agreement must be signed and dated (in blue ink)
  • Original signatures and dates on re-enrollment documents/agreements are verfied and must be signed in blue ink to authenticate

ADDITIONAL IMPORTANT FACTS

  • In-State providers will be required to provide proof of licensure prior to licensure expiration date (mail copy of updated license).
    • As providers complete the re-enrollment process, licensure end dates will be captured and licensure letters will be generated 60-days prior to the licensures expiration date
    • Re-enrollment of enrollment is required at a minimum of every five (5) years
    • Institutional providers are required to submit the application fee or verification of payment upon re-enrollment.
  • Medicaid will continue to terminate providers after one (1) year of inactivity - provider does not receive Medicaid reimbursement in a twelve (12) month period.
    • When a provider is terminated due to inactivity this provider is required to re-enroll
    • Providers are required to submit the application fee upon re-enrollment unless the provider can show evidence that they have paid the fee to Medicare or another state.
  • The online re-enrollment requires providers to enter their Medicaid provider number, not their NPI. Providers may locate their Medicaid provider number at the header section (first line on a remittance advice (RA). The provider's Medicaid number is the first number following, "PROVIDER NUMBER:" on the RA
    • Additional information on reading your remittance advice may be found in Chapter 6 of the CSM-1500, Dental or Institutional Manuals
  • Medicaid must suspend payments to a provider who is believed to be fraudulent. Program integrity will be required to show that this process is being followed and will be required to report on cases where payments have been suspended or not suspended and why.
  • Due to additional provider credentialing requirements, the overall enrollment process may take longer.

HOW WILL PROVIDERS BE NOTIFIED FOR FUTURE RE-ENROLLMENTS

As providers complete this initial re-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 this re-enrollment process as failure to comply will result in termination of your Wyoming Medicaid provider number and no payments will be made
    • Providers may begin submitting re-enrollments on May 1, 2014
    • Providers must have completed the re-enrollment process by December 31, 2015
  • Re-enrollment must be completed via the Medicaid Web Portal

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.

Waiver Group Enrollment Tutorial
Waiver Individual Pay-to Enrollment Tutorial
Waiver Individual Treating Enrollment Tutorial

BULLETINS

Final Re-Enrollment Reminder Notice
On-Line / Web Re-Enrollment