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Serving Wyoming Medicaid Providers

 

 

Frequently Asked Questions


 

General Provider Relations Questions

1.

How can I change my information on file (i.e. address, phone number)? Can this change be done over the phone?

 

  Demographic updates such as address, phone number and email address can be updated on the secure provider web portal, or by sending a letter with the provider's name and NPI or provider number to PO Box 667 Cheyenne WY 82003-0667.  Email address can be verfied and updated by contacting Provider Relation at 800-251-1268.

 

2.

Why are claims on my RA listed as in process? And should I resubmit  them?

 

A claim can be In process for a number of reasons including: (a) the recipient's eligibility is in question, (b) the claim has attachments that need to be reviewed by Wyoming Medical, and (c) the claim has posted edits that require personal attention. No, you should never resubmit a claim that is In process. This claim may be in process for up to 30 days, you will need to wait and see what happens with the claim. If the claim denies, the denial reason will be listed on your RA. Then you will know what steps need to be taken to correct the claim.

 

3.

How many office visits are allowed for clients over 21 years of age?

 

Thresholds for clients over 21 years of age include 12 office  and outpatient visits and 20 behavioral health visits.  Clients of all ages have a thresholds of 20 physical, occupational and speech therapy services , as well as 20 visits for chiropractic and dietician services.

 

4.

How do I waive a threshold limit for a particular client?

 

For Office visits, chiropractic services or dietician serivces you will need to complete the Authorization for Medical Necessity Form. This can be found in the forms section of this website. Starting with dates of service 11/1/17 for behavioral health, physical, occupational, or speech therapy services, you will need to contact Qualis Health at 800-783-8606. Dates of Service prior to 11/1/17, provider will need to complete the Authorizaiton of Medical Necessity .

5.

Does Wyoming Medicaid provide adult dental services?

 

Adult (21 years of age and older) dental coverage is limited to two preventative visits per year (including basic cleaning and x-rays) and emergency services and extractions.

6.

What is a timely filing limit for claims submissions/adjustments?

 

Providers have 12 months from the date of service or within 6 months from the payment date on the Explanaton of Medical Benefits (EOMB), whichever is later.  Adjustments must be received within 6 months of the claim payment date.

7.

What modifiers are allowed with which procedure codes?
 

Providers can review the online fee schedule (https://wymedicaid. portal.conduent.com/end_user_agmt.html) to search for valid or invalid modifiers by procedure codes. Providers can also contact Provider Relations at 800-251-1268 regarding allowed modifiers for specific procedure codes. . 

 

8.

What procedure codes require Prior Authorization?

 

Providers can review the online fee schedule (https://wymedicaid.portal.conduent.com/end_user_agmt.html) to tell if a procedure code requires prior authorization. Providers can also contact Provider Relations at 800-251-1268 regarding which procedure codes require prior authorization.

 

9.

What is the payment cycle?

 

Claims are typically processed on Wednesday evening and checks or EFTs are generated on Friday.  Please note that for EFT payments, the banks have three business days to post these payments to your account.  There are some exceptions to these processing dates which can be found on the Provider Welcome page titled Payment Exceptions.  

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Provider Enrollment Questions

1.

When do I need to re-enroll with Medicaid?

 

The Afforable Care Act ACA requires that all Medicaid providers re-enroll at least every five (5) years.  (Additional information regarding the ACA re-enrollment can be obtained at https://wymedicaid.portal.conduent.com/aca_reenrollment.html or by calling Provider Relations at 1-800-251-1268) Other reasons to re-enroll incllude a change to the provider's Tax ID and ownership, and provider's enrollment being terminated for inactivity.

 

2.

How will I know when I need to re-enroll?

 

As long as the provider remains active for the five year enrollment period, notifications will be generated and mailed to providers 60 days prior to the provider's enrollment expiration date. 

 

3.

Is Ownership information required?

 

Yes, if you are enrolling as a group or a pay-to-provider/facility.  If you are enrolling as a treating provider or an Ordering, Rendering, or Prescribing (ORP) provider, you do not need to complete ownership but a DOB & SSN will be required (this can be entered under "Type of Business" , choose Indiviidual Treating Provider to be able to enter the DOB).

 

4.

Can my enrollment be backdated?

 

As of 7/1/17 enrollments can no longer be backdated.

 

5.

Who needs to sign the supplemental documents for an enrollment?

 

Any authorized official determined by the provider may sign the supplemental documents.

 

 

 

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