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Serving Wyoming Medicaid Providers

 

 

Frequently Asked Questions

Scroll down or click on one of the categories below to view its most frequently asked questions:


 

General Provider Relations Questions

1.

How do I become enrolled with a group?

 

If both the group and the treating provider are already enrolled with Wyoming Medicaid, a letter must be sent in requesting that the individual provider <provider's name>, and NPI number <state provider's NPI number>, be linked to group <group provider's name> and NPI number <state group provider's NPI number>, effective on this date <state date the provider link should begin>.  Send the letter to PO Box 667 Cheyenne WY 82003-0667or fax to 307-772-8405.

 

2.

How can I change my enrollment information, 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 prortal, or by sending a letter with the provider's name and NPI or provider number to PO Box 667 Cheyenne, WY 82003-0667.  Email addresses can be verified, and updated by contacting Provider Relations at 800-251-1268.

 

3.

When is it acceptable to fax a claim?

 

Contact Provider Relations at 800-251-1268 for questions regarding claims. or if a claim is within one week of timely filing.  Claims can only be faxed if requested to the call center representative that requested the claim.

 

4.

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.

5.

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

 

Clients 21 years old and over are allowed 12 office  and outpatient visits and 20 physical, occupational  and speech therapy visits per calendar year.  If a client has exceeded the Medicaid limits on these visits, you may bill him/her or request the cap limit be waived.

 

6.

How do I waive a cap limit for office visitsir therapy visits?

 

Waiver requests will need to be made using the Medicaid Cap Limit Waiver Request Form (from website: http://wymedicaid.acs-inc.com/forms.html) or manual (Section 6.6.2 in the provider manual) and must cite specific medical necessity.  The Cap Limit Waiver Request Form must be signed by a physician or nurse practitioner when requesting to waive office/outpatient visits, or a physical, occupational or speech therapist when requesting to waive therapy visits.  Mail the letter / Cap Limit Request Form to PO Box 667 Cheyenne, WY 82003-0667 (Attention Medical Policy)

 

7.

Does Wyoming Medicaid provide adult dental services?
 

Adult (21 years of age and older) dental coverage is limited to one preventative visit per year (including basic cleaning and x-rays) and covers basic fillings, emergency services, and full and partial dentures. 

 

8.

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.

 

9.

What modifiers are allowed with which procedure codes?

 

Providers can review the online fee schedule (https://wymedicaid.ac-inc.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.

 

10.

What procedure codes require Prior Authorization?

Providers can review the online fee schedule (https://wymedicaid.acs-inc.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.

 

WINASAP Software Questions

1.

a. What is WINASAP?

 

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.  The software is also available for download from this web site's Software page.

 

 

b. Do I need a clearinghouse/billing agent?

 

No, you do not need a clearing house/billing agent: however, you will need to fill out an EDI Enrollment Form that is available on the website (https://wymedicaid.acs-inc.com/forms.html).

 

2.

If I am a clearninghouse/billing agent, do I need a Trading Partner ID (TPID) number?

 

Yes, if you are submitting any electronic transactions.

 

3.

Will I receive confirmation that my claims have been received?

 

WINASAP allows submitters to run several types of reports to review claims submission  Review  WINASAP tutorial available on the website (https://wymedicaid.acs-inc.com/software.html) for details on these reports.

 

Provider Enrollment Questions

1.

a. 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.acs-inc.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.

b.  How will I know when I need to re-enroll?
After a provider completes the re-enrollment, notifications will be generated and mailed to providers 60 days prior to the provider's enrollment expiration date.

 

c. Do I need to enroll again to submit  Electronic Claims?

 

Yes, when you re-enroll with Wyoming Medicaid you will also need to re-enroll with the ACS-EDI Clearing House.  The EDI enrollment application is included in the Wyoming Medicaid enrollment form.

 

2.

What is meant by "group" enrollment?

 

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.  Both group and individual providers complete the same Wyoming Medicaid Enrollment Form.

 

3.

What license is required for enrollment?

 

The license must be from the state that matches the provider's physical location.

 

4.

Who must have a DEA number?

 

Every physician must have a DEA number with the exception of anesthesiologists, pathologists, radiologists and physician assistants.

 

5.

Who needs to sign a Provider Agreement?

 

Every provider wishing to enroll with Wyoming Medicaid must have a signed (signature must be in blue ink) Provider Agreement.

 

6.

Does Wyoming Medicaid enroll podiatrists, chiropractors, and physicians assistants?

 

Yes, for Medicare crossovers only.

 

7.

 I received a letter says my licensure or certification is about to expire.  Do I need to re-enroll?

 

No, this letter means that Wyoming Medicaid is requesting a copy of your current professional license that matches the state of the practice, or provider's physical location.

8.

Do out-of-state providers needs a Wyoming license?

 

No, Wyoming Medicaid requires a copy of a license from the state of the practice, or provider's physical location..

 

9.

How do I add a new physician to my group?

 

a. If the physician is already enrolled as a Medicaid of Wyoming provider, you must send a letter requesting that the individual provider <provider's name> and NPI number <state provider's NPI number>, be linked to group <group provider's name>, and NPI number <state group provider's NPI number>, effective on this date <state date the provider link should being> .  Send the letter to PO Box 667 Cheyenne, WY 82003-0667.

 
 

b. If the new physician is not a Wyoming Medicaid provider, you will need to complete the enrollment process. The forms can be obtained at http://wymedicaid.acs-inc.com/ or by calling Provider Relations at 1-800-251-1268.


10.

If I have changed my Tax ID, can I request that it be changed on my provider file?

 

If both the Tax ID and the ownership have changed, a new enrollment form will need to be completed. if the provider's Tax ID has changed and the ownership has not, a letter requesting the change of Tax ID needs to be sent on the provider's letterhead.  This letter must state that the provider <state providers name> with the providers NPI and/or provider number's <state providers NPI/or provider number> Tax ID has changed from <state old Tax ID number> to the new Tax ID number <state new Tax ID number> effective on this date <state effective date>.  This letter must also state that there has been no change in ownership.  Send this letter to PO Box 667 Cheyenne, WY 82003-0667 or fax to 307-772-8405..

 

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