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Billing Provider Taxonomy Requirements

Attention All Billing Providers

Wyoming Medicaid requires taxonomy codes to be included on all claim submissions for billing, attending, AND servicing/rendering providers.

Billing Provider / Credentialing Staff are required to verify that the rendering/servicing providers:

  • have an active enrollment status with Wyoming Medicaid
  • enrollment effective dates are accurate
  • association to the group is complete and with the appropriate dates
  • primary taxonomy and secondary taxonomies are accurate and have the appropriate dates
 

Claim Denials / Provider Action May Be Required:

  • Medicaid has denied claims from 200 plus providers for the above reasons
  • Billing providers and credentialing staff need to validate and update their provider enrollments and resubmit denied claims.
  • Claims denials occurring from 10/24/2021 to current for this reason posted the Medicaid Error Code 1452 - Invalid or missing servicing or rendering provider at header with the associated Claim Adjustment Reason Codes (CARC)/Remittance Advice Remark Codes (RARC):
    • 16: claim or service lacks information or has submission or billing errors
    • N290: missing, incomplete, or invalid rendering Provider primary identifier
 

Billing Provider/Credentialing Staff Action Steps:

  • To verify and update information billing providers may access their provider enrollment file by logging into your Provider Portal and submit a “Change of Circumstance”, if applicable, with HHS Tech Group (https://wyoming.dyp.cloud/) the Provider Enrollment vendor.
  • Training materials are listed under "Info for Providers" on the DYP, HHS Tech Group website.
  • Questions regarding enrollment or Change of Circumstances that are not addressed in the training materials may be directed to:
  • Allow 1 to 2 business days for updates (Change of Circumstances) to appear in the Wyoming Medicaid Provider Portal prior to submitting claims.
  • If all enrollment information is accurate submit a new claim and include a taxonomy code for attending and/or rendering providers.

Wyoming Medicaid 2023 January & February Payment Exception Calendar

Attention All Billing Providers

The January and February 2023 Wyoming Medicaid Payment Exception Schedule has been posted to the Medicaid website: https://www.wyomingmedicaid.com/portal/Payment-Exceptions.

For the months of January and February there are NO payment exceptions. Payments will process according to the normal weekly payment schedule, as follows:

Medicaid payment runs on Wednesdays, the State Auditor's Office (SAO) runs payment on Thursdays, and EFT (electronic fund transfers) and check mail dates occur on Fridays.

Paper Remittance Advices (RAs) and 835s are delivered on Fridays. The payment exception schedule documents the changes to the normal weekly payment schedule.

Keep in mind, the EFT date is the date the SAO transmits the payment to banks (financial institutions), and they have up to three (3) business days to post to accounts.

January 2023 WY Medicaid Mandating Use of Value Codes 80 & 81

Attention Wyoming Medicaid Nursing Facilities & Swing Bed Providers:

Wyoming Medicaid mandated the use of value codes 80 (covered days) and 81 (non-covered days) back on January 1, 2022. The Field Representatives have been training facilities since August 2022 and providers have access to the Nursing Home Training Tutorial (https://www.wyomingmedicaid.com/portal/Provider-Training%2C-Tutorials-and-Workshops), and should specifically review slides 36 – 65 for billing requirements and examples for the use of these value codes. As a reminder these value codes are used in the covered days calculation for provider payment.

NOTE: If there are no leave days during the month, providers are NOT required to enter value code 81 with “0” days, they should only enter value code 80 with appropriate days.

Unfortunately, many nursing homes and swing bed providers have continued to submit claims without these codes, which could negatively impact Medicaid payments made to the facility. All nursing home and swing bed claims are required to be submitted with the value codes of 80 and 81.

Effective January 1, 2023, when providers do not submit nursing or swing bed facility claims with value codes 80 and 81, Medicaid will deny the claim with an appropriate error code.

Error Code Error Code Short Description
1818 Nursing facility claim where room and board revenue codes reported and no value codes
7075 Inst. Care invalid calc days vs. Billed

It is important for the provider’s office staff to read this billing requirement change in Wyoming Medicaid Policy. It is your responsibility to forward to the appropriate staff to ensure they take appropriate action.

Attention Patient Centered Medical Home (PCMH) Providers

Due to an increased number of denials, the Wyoming Medicaid PCMH Team would like to send a reminder, that a rendering provider is required to be listed on all claims, including PCMH quarterly billing.

Requirements for the rendering provider:

  • Must be actively enrolled with Wyoming Medicaid
  • Must be associated to your billing group
  • Must be an individual; the group NPI cannot be used as both the billing and rendering provider

In past trainings it was recommended to use the medical director as the rendering on claims, or any provider assisting with the management of the program in your office. It is acceptable for the rendering provider to be the same for all members and dates of service.

Billing Requirements:

  • Submit claims with the rendering providers 10-digit NPI
  • Taxonomy code is required for rendering providers
  • PCMH procedure code: S0281 – medical home

Please feel free to reach out with any questions or concerns.

Thank you for continuously providing exceptional care to the residents of Wyoming!

Wyoming Medicaid Requirement for ALL Providers!

Wyoming Medicaid communicates to providers via email and also the Wyoming Medicaid website (https://wyomingmedicaid.com/). Communications include but are not limited to new Medicaid Policy and Billing Requirements, updates to existing policy and billing, provider training opportunities, and provider education.

As mentioned in the Provider Manuals, providers are to keep email and phone numbers updated to ensure the PROVIDER’s OFFICE can be reached and receive these notices. Medicaid is discovering the emails and phone numbers are for provider credentialing and billing agents or clearinghouses. Providers need to add at minimum one valid office phone number and one office email address to their provider enrollment file by logging into your Provider Portal and submitting a “Change of Circumstance” with HHS Tech Group (https://wyoming.dyp.cloud/) the Provider Enrollment vendor.

When Provider Services or the Field Representatives attempt to contact providers and are not able to speak to the provider or office staff, their provider status may be changed to “inactive” until the office contact information is updated resulting in a delay of Medicaid payments. To avoid this, act now and update your provider contacts to include an office contact.

Hospice Routine Home Care 61-Days & Beyond and SIA Reimbursement Updates

Attention Hospice Providers

On December 17, 2022, Wyoming Medicaid implemented the Hospice Change Request to reimburse providers accurately for Routine Home Care (0651) for 61 Days and Beyond (G0493 & G0494) and Service Intensity Add-On (SIA) services for the last 7 days of a member’s life (G0162).

Providers may monitor the above system change requests and known system issues document, Known Issues Log, which is accessible from the home page on the Wyoming Medicaid website. The Known Issues Log will also provide updates on the timeline for reprocessing of these claims outlined below.

Upon implementation of this change request, paid claims will be adjusted which may result in a change in payment. Denied claims will be resurrected for reprocessing.

There is no change to the policy, but there are billing requirement expectations which are outlined below via billing examples.

Hospice Covered Services:

Revenue Code Procedure Code Description
0651   Day 1 through day 60
0651 G0493 61 days and beyond – skilled services of a registered nurse (RN) for the observation and assessment of the patient’s condition
0651 G0494 61 days and beyond – skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patient’s condition
0651 G0162 Service Intensity Add-On (SIA) services for the last 7 days of a member’s life
  • 16 max daily units (4 hours/day, 15 minutes = 1 unit)

Billing Example 1:

  • Coverage from/to date span (header): 11/01/2022 – 11/30/2022
  • Member reaches 61 days: 11/16/2022
    • 61 days and beyond G0493 (RN) or G0494 (LPN)
  • Submit one claim with two (2) lines and appropriate service dates on each line
    • Dates of service on the lines MUST be different and accurate
  • Claim details:
    • Header coverage dates: 11/01/2022 – 11/30/2022
    • Line 1 (routine home care services):
      • Revenue code: 0651
      • Procedure code: Do NOT enter a procedure code
      • Dates of service: 11/01/2022 to 11/15/2022
      • Units: 15
      • Submitted charges: Enter usual and customary charges
    • Line 2 (61 days and beyond - skilled services)
      • Revenue code: 0651
      • Procedure code: G0493 (RN) OR G0494 (LPN)
      • Dates of service: 11/16/2022 to 11/30/2022
      • Units: 15
      • Submitted charges: Enter usual and customary charges

Billing Example 2:

  • Coverage from/to date span (header): 11/01/2022 – 11/25/2022
  • Member reaches 61 days: 11/16/2022
    • 61 days and beyond G0493 (RN) or G0494 (LPN)
  • Date of death on file for member: 11/25/2022
    • Service Intensity Add-On (SIA) services for the last 7 days of a member’s life: G0162
  • Submit one claim with three (3) lines and appropriate service dates on each line
  • Claim details:
    • Header coverage dates: 11/01/2022 – 11/25/2022
    • Line 1 (routine home care services):
      • Revenue code: 0651
      • Procedure code: Do NOT enter a procedure code
      • Dates of service: 11/01/2022 to 11/15/2022
      • Units: 15
      • Submitted charges: Enter usual and customary charges
    • Line 2 (61 days and beyond - skilled services)
      • Revenue code: 0651
      • Procedure code: G0493 (RN) OR G0494 (LPN)
      • Dates of service: 11/16/2022 to 11/25/2022
      • Units: 10
      • Submitted charges: Enter usual and customary charges
    • Line 3 (SIA services for the last 7 days)
      • Revenue code: 0651
      • Procedure code: G0162
      • Dates of service: 11/19/2022 to 11/25/2022
      • Units: 112
      • Submitted charges: Enter usual and customary charges

Billing Example 3:

  • Coverage from/to date span (header): 11/01/2022 – 11/25/2022
  • Date of death on file for member: 11/25/2022
    • Service Intensity Add-On (SIA) services for the last 7 days of a member’s life: G0162
  • Submit one claim with two (2) lines and appropriate service dates on each line
  • Claim details:
    • Header coverage dates: 11/01/2022 – 11/25/2022
    • Line 1 (routine home care services):
      • Revenue code: 0651
      • Procedure code: Do NOT enter a procedure code
      • Dates of service: 11/01/2022 to 11/25/2022
      • Units: 25
      • Submitted charges: Enter usual and customary charges
    • Line 2 (Service Intensity Add-On [SIA] services for the last 7 days)
      • Revenue code: 0651
      • Procedure code: G0162
      • Dates of service: 11/19/2022 to 11/25/2022
      • Units: 80
      • Submitted charges: Enter usual and customary charges

Attention Hospital, Nursing Home and Swing Bed Providers

Beginning January 1, 2023, psychosocial assessments will no longer be needed prior to submitting the PASRR Level II packet. Telligen, the PASRR Level II vendor, will be scheduling interviews to complete this part of the process. Wyoming Medicaid hopes this will allow individuals to move into nursing homes at a quicker pace.

The following is the process for new PASRR Level II, this includes resident reviews:

1. Hospital or Nursing Home completes the PASRR Level I.

  • PASRR Level I summary is a 0. Individual can be admitted to nursing home.
  • PASRR Level I summary is 4, 5, 6, 7 or 8, documentation for categorical is uploaded to Telligen system. Individual can be admitted.
  • PASRR Level I summary is 1, 2 or 3. Hospital or Nursing home must upload information, excluding psychosocial if one has not been completed in the last year, to Telligen system. Individual cannot be admitted until notice of determination and report has been completed by Telligen.

2. Hospital or Nursing Home will determine if there has been a psychosocial completed in the last year. If still relevant, submit it with the PASRR Level II packet into the Telligen system.

3. If no psychosocial is found, Hospital or Nursing Home will upload all other documents to the Telligen system.

4. Make sure to put any contact information in the case that would assist with scheduling an interview with family members, health staff and/or member.

5. Telligen will review case and, if a psychosocial has not been uploaded to case, will schedule interview with contact information.

6. Telligen will complete interview with individuals.

7. Telligen will review all documentation including information received during interview and make a determination of placement. Once this has been completed and the notice of determination/report have been uploaded to case, individual can be admitted.

The PASRR process is a federal regulation. It must be completed prior to admission. If it is not completed prior to admission, nursing homes will not be paid for the days prior to the completion of the PASRR process. PASRR Level II cannot be backdated. Date of determination will be the date that a completed PASRR Level II packet was submitted to Telligen.

If you have any questions or concerns, please feel free to contact Amy Guimond at amy.guimond@wyo.gov.

Reminder: Wyoming Medicaid Provider Services Mailing Address

Wyoming Medicaid Providers are reminded of the Wyoming Medicaid Provider Services Mailing Address. This address became effective October 25, 2021, when CNSI assumed operations as the new fiscal agent for the Wyoming Medicaid program. That mailing address is as follows:

Wyoming Medicaid
Attn: Provider Services
P.O. Box 1248
Cheyenne, WY 82003-1248

Wyoming Medicaid reminds its providers that it’s a provider’s responsibility to update all necessary records and to notify third party vendors, including billing agents and clearinghouses, of the new mailing address.

The previously used mailing address is no longer effective and should not be utilized. That mailing address was as follows:

Wyoming Medicaid
Attn: Provider Services
P.O. Box 667
Cheyenne, WY 82003-667

Providers are encouraged to visit the Wyoming Medicaid website regularly for What’s New articles, Provider Manuals and Bulletins updates ,Contact Us, and Provider Trainings and resources.

Reminder: DMEPOS Documentation and Policy Requirements

Attention DMEPOS providers:

Wyoming Medicaid has been conducting a number of post pay claims reviews over the last 18 months and is sending this reminder of policy and documentation requirements that must be met.

A number of reviews found that one or more of these documentation requirements or policy items were not met. In the case of an audit or post pay review, this could result in the recovery of any payment made on any claim that fails the review for these items.

Please take the time to review these items, along with the Wyoming Medicaid DME Manual (available on Telligen’s website – https://wymedicaid.telligen.com, located in the Document Library) to ensure your office is compliant with these requirements.

Face to Face Visit (DME Manual – Page 13):

For any Durable Medical Equipment (DME) item initially prescribed, the DME provider must have on record the date of the face-to-face visit with the prescribing provider, which must be within the previous six months. The exception to this requirement is for renewal orders for ongoing prescriptions such as incontinence supplies, oxygen, etc. This face-to-face may be completed by telehealth but not telephonically.

Prescriptions (DME Manual – Pages 14 - 15):

All Durable Medical Equipment and Prosthetics and Orthotics (DMEPOS) items must have a written prescription. This prescription cannot span more than 1 year. All prescriptions must be renewed when expired in order for coverage to continue for the prescribed item(s).

Note: Written orders are required prior to claim submission for all items or services billed, even items dispensed based on verbal order.

Documentation Requirements (DME Manual – Pages 14 - 17)

Documentation is required to be maintained by the DMEPOS supplier in addition to the documentation maintained by the prescribing provider. Please review this section and ensure your records are complete for each claim submitted to Wyoming Medicaid. This includes maintaining the following:

  • Current, original physician orders
  • Documentation of ordering practitioner’s face-to-face visit with the member, including date and practitioner’s name
  • Certificate on Medical Necessity and additional medical necessity information provided by the physician or required by Wyoming Medicaid
  • Proof of delivery
  • Verification of continued need for ongoing supplies before shipping
  • Approved prior authorization (when required); and
  • Documentation supporting the member or caregiver was provided with manufacturer instructions, warranty information, service manual, and operating instructions.

Note: Documentation must be kept in the DME provider files for six (6) years from date of service.

Rental Items (DME Manual – Pages 17 - 18):

Items supplied on a rental basis must always be billed with the RR modifier. Dates of service should cover the rental period but not be for future dates. The rental period is not billable until the dates have passed. For example, a rental for 10/1/22 – 10/31/22 cannot be billed until 11/1/22 at the earliest.

Future Dates of Service:

Wyoming Medicaid claims cannot include dates of service in the future. Items purchased should be billed using the single date of service the item was purchased on, and not a span of dates the items are intended to cover. If a member buys a 30-day supply of incontinence supplies on 1/15/22 for use during the following month (1/15/22 – 2/14/22), the date of service should be 1/15/22 only.

Supplies and Equipment for Nursing Facility Residents (DME Manual – Page 19):

Items for use by residents in the nursing facility are generally the responsibility of the nursing facility to provide and are covered under the nursing facility’s per diem rate.

In order for an item to be covered when supplied by a DMEPOS provider, the item must be customized in such a way that no other resident of the facility would be able to make use of the item after the current owner no longer needs it. Examples include

  • Orthotics and prosthetics
  • Ventilators
  • Hearing aids
  • Customized wheelchairs (shaped seating systems, etc.)

Note: This item must be medically necessary and must be documented why a lesser system cannot be utilized.

For any questions regarding DME Policy or Documentation Requirements, please contact Amy Guimond at amy.guimond@wyo.gov.

Update: Electronic Claims Submission Policy

Due to provider feedback received regarding mandatory paper claims billing November 1, 2022, the following updates and additional guidance is being provided:

1. If the service or equipment is not covered under the member's plan, or the insurance company does not cover the service or equipment, then Medicaid will process the claim as being primary.

  • TPL/Other Insurance Electronic Billing Requirements:
    • Indicate claim requires supporting documentation – triggers attachment indicator as Y
    • Submit claim to Medicaid as secondary – enter appropriate Payer ID (list is available on the TPL and Medicare Payer IDs web page on the WY Medicaid website)
    • Enter TPL paid amount $0.00
    • At the line enter full billed dollar amount and enter Claim Adjustment Reason Code (CARC) code 204
    • Attach either the blanket denial letter on the primary payers letterhead or the primary insurance Explanation of Benefits (EOB).

2. Providers who must have Out of Policy exceptions done for certain nursing home Durable Medical Equipment (DME) items may continue to bill on paper.

3. Providers who have a Letter of Agreement (LOA) with the Wyoming Department of Health (WDH) may continue to bill on paper.

4. Providers who are working with a WDH or CNSI representative to process/special batch paper claims may continue to work with those representatives and bill on paper when necessary. This includes providers who submit a blanket denial letter for clients with Cigna coverage that is primary to Medicaid.

Please note: The previous list of items may be updated in the future to require electronic billing. A notification will again be provided when those changes are made.

For questions, please contact Provider Services at 1-888-WYO-MCAD or 1-888-996-6223.

Thank you for your attention to this matter.

Wyoming Medicaid – Tired of Holding for the Next Available Representative?

Tired of Holding for the Next Available Representative?

The changes outlined below are being implemented to allow providers to view the same error codes the call center representatives see. These are Medicaid specific which should reduce the need to call on every claim denial. The Member Eligibility enhancements give providers the capability to search on codes, claim history, and limits, just to mention a few.

In addition to this bulletin, the Wyoming Medicaid Field Representatives will be offering provider workshops the last week of September through the second week of October 2022. The workshops’ focus will be on a complete review of these three enhancements which will give providers more resources within the secure Provider Portal to troubleshoot and avoid claim denials.

There will also be updates to both the ‘Retrieving Paper RA’ Quick Reference Guide (QRG) and the ‘Member Eligibility, Code Review/Service Limits, Historical Claim Searches’ QRG, formerly called 'Provider Member Eligibility Search.' QRGs are located on the Provider Training, Tutorials and Workshops web page.

If providers need assistance with these changes or have questions about how to register for a provider workshop, please contact the Provider Services Call Center (1-888-WYO-MCAD or 1-888-996-6223).

Enhancement – Error Codes will display on Provider Portal

Effective September 5, 2022, the provider view of claims in the secure Provider Portal will include Medicaid-specific error codes. This will assist providers in determining claim or line denial reasons.

To see these error codes in claims on the secure Provider Portal, providers will need to sign into the Wyoming Medicaid Provider Portal, select ‘Claims Access’ as the profile, then select the Claim dropdown menu, and then select ‘Claim Inquiry.’

Note: Providers can search for claims by TCN or other filter options.

First, select the TCN hyperlink of the claim that is to be viewed.

After selecting the TCN hyperlink, the claim will open and providers will be able to view the Medicaid error codes and their corresponding description, along with the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) that are currently available.

Next, select the notebook icon to view line item information

There will be provider workshops coming soon that will offer additional details on claim inquiry searches using the ‘Filter By’ options, how to download claim search results, and more.

Enhancement – Paper Remittance Advice (RA) Enhancement

Effective September 9, 2022, providers will experience an enhancement to paper Remittance Advices (RAs). This paper RA enhancement allows providers to see Medicaid-specific error codes. CARCs and RARCs that are currently visible will continue to display on all RAs.

Member Eligibility Enhancement

Effective September 5, 2022, Member Eligibility Search screens have been expanded to provide information without having to visit several places. It is designed to save you time when planning services for a member. With this new eligibility enhancement, there will be fields where you can specify the procedure and diagnosis codes you plan to use. The result will have details as to whether or not those codes are valid and if a Prior Authorization (PA) is required for the member for the service you plan.

Utilization for such things as vision and dental will also display so you know if the member has utilized those services. This will give accurate information to help determine what is available to the member before you see them. For example:

  • The member calls to schedule an eye exam
  • A Search is complete on the Enhanced Eligibility page
  • The result shows that the member had an eye exam 6 months ago conducted by a different Vision provider
  • Medical necessity needs to be assessed prior to the appointment so you know what can be billed to Wyoming Medicaid.

Inquiry Detail page

View of what Providers will see when they enter info in the Eligibility Search

The result from the inquiry shows a “Yes” for the Procedure Code. Clicking on the “Yes” will take you to additional information.

The procedure code shows that this member is allowed 2 units per 365 days and that they have already used their units for the current 365-day period.

Note: The disclaimer is at the top of each page. Eligibility shown does not always result in a payment of services.

Keeping Your Provider Number Active and Accurate

The COVID-19 Public Health Emergency (PHE) exceptions may be ending soon. To prevent Suspension for an expired license or Termination for a missed re-validation, please also check your contact information (i.e., phone numbers, address, emails) as these could also cause your provider number to suspend.

Please access your provider portal through the Discover Your Provider (DYP) website to update your provider records or submit a revalidation application.

For questions regarding your provider file, please contact HHS Tech Group at 1-877-399-0121.

Electronic Claim Submission Policy

Attention Wyoming Medicaid Providers:

Effective November 1, 2022, all original claims submitted to Wyoming Medicaid must be filed electronically. CNSI, the Fiscal Agent, will no longer accept paper claims for any Medicaid service.

Note: This first phase will be ending all original submissions of paper claims on November 1, 2022.

The next phase will include ending claim adjustments submitted on paper. However, more information and notices will be sent to providers before this occurs.

Provider Resources:

Please visit the Wyoming Medicaid website for additional future information regarding the end of Wyoming Medicaid original paper claims.

NotificationsPast Notifications