Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3)

What this rule requires your agency to do

• 1A provider shall make financial and client medical records available upon request to the Department, HHS/HCFA, the Comptroller General, the Wyoming Attorney General, or the MFCU; refusal results in immediate suspension of all Medicaid payments and repayment within ten (10) days of written request (Section 8(d), (f)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 2For covered services, a provider may not request, receive, or attempt to collect any payment from the client or the client's family, and shall accept the Medicaid allowable payment as payment in full (Section 12(b)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 3Before providing services that require prior authorization, the provider shall request authorization on the forms specified by the Department; failure to obtain prior authorization precludes Medicaid reimbursement (Section 10(a)-(b)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 4A provider shall maintain medical and financial records, including dates of service, diagnoses, services furnished, and claims, for at least six (6) years after the end of the state fiscal year in which payment was rendered, with the first three (3) years in hard copy (Section 8(c)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 5A provider proposing a change in ownership, control, operation, management contract, or leasehold interest shall notify the Department in writing no later than sixty (60) days before the effective date of the proposed change (Section 6(d)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 6No Medicaid funds shall be paid to any individual or entity unless it is party to a fully executed provider agreement and enrolled by the Department (Section 5(a)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 7To qualify for enrollment, a provider must meet applicable licensing and certification standards, not be OIG-excluded from federally funded health care programs, and be assigned an NPI as applicable (Section 4(b)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))
• 8Claims shall be submitted and finalized on or before twelve (12) months after the date of service or discharge (whichever is later), except Medicare cross-over claims within six (6) months after Medicare acts and retroactive-eligibility claims within six (6) months of the eligibility determination (Section 13(g)(vi)).(Wyoming Medicaid Rules, Chapter 3 — Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims by Providers (Wyo. Code R. 048.0037.3))