Scroll down or click on one of the categories below to view its most frequently asked questions:
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1. |
How do I become enrolled with a group? |
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To become enrolled in a group, an individual provider must send a written request to ACS, asking to be crossed to the group. |
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2. |
How can I change my enrollment information, i.e. address, phone number? Can this change be done over the phone? |
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All changes must be submitted in writing. No, this can not be done over the phone. |
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3. |
When is it acceptable to fax a claim? |
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ACS accepts faxed claims only if the date of service is within the week of timely filing. |
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4. |
Why are claims on my RA listed as “In process”? And should I resubmit them? |
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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 ACS' Medical Policy Unit, 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. |
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5. |
Do I need a different provider number for Medicaid, CHS or BCC |
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No, you use the same provider number regardless of which program the recipient belongs to. |
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6. |
How many office visits are allowed for clients over 21 years of age? |
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Clients 21 years old and over are allowed 12 office visits and 20 physical and occupational therapy visits per calendar year. |
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7. |
How do we waive a caplimit for officevisits/PT/OT visits? |
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The Provider would need to send a letter to ACS, Attn: Medical Policy, citing the medical necessity for the extra visits. The letter must be signed by the physician, nurse practitioner, physical therapist, or occupational therapist. Also the client must have already had 12 office visits. |
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8. |
How many dental visits / extractions are allowed for clientsover 21 years of age? |
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Clients 21 years of age and older are allowed two emergency visits per calender year for the relief of pain. EqualityCare will pay for as many extractions as are medically necessary. |
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9. |
What is a timely filing limit for claims submission? |
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Providers have 1 year from the date of service or 6 months from the Medicare paid/denied date to receive payment on a correct claim. |
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10. |
What modifiers are allowed with which procedure codes? |
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Please contact Provider Relations Unit (1-800-251-1268) for procedure code / modifier questions. |
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11. |
What procedure codes require Prior Authorization? |
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Refer to the "publications" page on the wyequalitycare.acs-inc.com website for all EqualityCare fee schedules. These will provide PA information as well as allowable on CPT and HCPCS codes. |
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12. |
What do all of the EOB (Explanation of Benefit) codes mean? |
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Refer to the "billing manuals " page on the wyequalitycare.acs-inc.com website for all EqualityCare EOB codes and descriptions. |
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1. |
a. What is WINASAP? |
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WINASAP is a Windows-based
electronic claims entry application for Wyoming
Medicaid. This software application was developed
to provide an alternative to submitting claims
on paper. |
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b. Do I need a vendor? |
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This is up to the facility. Wyoming
Medicaid provides the free WINASAP software.
The software is also available for download from
this web site's Software
page. |
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2. |
a. If I am a vendor, do I need a provider number? |
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Yes, if you are submitting claims electronically. |
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b. How can I obtain a provider number for WINASAP? |
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You will need to contact ACS-EDI Clearing House. |
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3. |
Will I receive confirmation that my claims have been received? |
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Yes, you will receive a summary of your billing and a notice that your claims have either been submitted successfully or rejected. However, WINASAP will not indicate claim status, i.e. denied, paid, etc. |
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1. |
a. When do I need to re-enroll
with Medicaid? |
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A provider must re-enroll if: (a) there has been a change to the provider's Tax ID, (b) the provider has moved to a different state, or (c) the provider has become a Pay-to-Provider as opposed to a Treating Provider only. |
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b. Do I need to re-enroll with EDI to submit Electronic Claims? |
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Yes, when you re-enroll with ACS you will also need to re-enroll with the ACS-EDI Clearing House. |
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2. |
What is meant by "group" enrollment? |
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A group is made up of at least two like providers under the same Tax ID. To enroll as a group, the group must submit a Group Enrollment form and each treating provider must submit a Provider Enrollment application. |
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3. |
What license is required for enrollment? |
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A license from the state in which the provider is rendering services. |
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4. |
Who must have a DEA number? |
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Every physician must have a DEA number with the exception of anesthesiologists, pathologists, and radiologists. |
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5. |
Who needs to sign a Provider Agreement? |
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Every provider wishing to enroll with Wyoming Medicaid must have a signed Provider Agreement. |
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Does Wyoming EqualityCare enroll podiatrists, chiropractors, and psychologists? |
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Yes, for Medicare crossovers only. |
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7. |
Who must DD Adult/Children waiver providers enroll through? |
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These providers must enroll through the division of Developmental Disabilities. |
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8. |
Why did I receive a letter saying my licensure or certification is about to expire? Do I need to re-enroll? |
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No, this letter means that ACS is requesting a copy of your current professional license for the state you practice in. |
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9. |
Do out-of-state providers needs a Wyoming license? |
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No, ACS requires a copy of a license from the state that the services are rendered in. |
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10. |
How do I add a new doctor to my group? |
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a. If the physician is already a Medicaid of Wyoming provider, you can send a letter with the new doctor's name and provider number along with the group name and number and the effective date. |
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b. If the new physician is not a Wyoming Medicaid provider, you will need to complete the enrollment process. The forms can be obtain at http://wyequalitycare.acs-inc.com/ or by calling Provider Relations at 1-800-251-1268. |
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11. |
How do I cross a Medicare number to my group? |
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Send the Medicare number in writing with a request to cross it to the group provider number. |
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12. |
If I have changed my Tax ID, can I request that it be changed on my provider file? |
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No, you must complete a new Provider Enrollment application and a new Provider Agreement. |
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