What's New

Increased Security Measures to Protect Data

As part of the implementation of the new Benefits Management System and Services (BMS) system, information security functions and practices have been modernized to align with current federal requirements, security best practices and the threat environment. The Wyoming Department of Health (WDH) understands that adherence to security standards can create additional work. However, the current threat environment and the rise of cyber-crime presents a very real threat to the system and its data, including your data.

Weak measures and controls can be exploited and result in security breaches that can disclose protected data and damage systems. Therefore, WDH has implemented protective measures that are mandated by federal requirements and align with security best practices. These measures and controls are used by other institutions such as your bank and include:

  • Multi-Factor Authentication (MFA) for website access – This was introduced and described in a previous notice. Please understand that this prevents someone from being able to guess or steal your password and from using your account to steal data.
  • Authentication requirements for accessing protected information – WDH understands that these can be inconvenient, especially when a provider is receiving a call back over a particular issue. However, protected information simply cannot be shared without proper authentication. When information is needed, the best option is to use the secure portal rather than contacting the call center.

Thank you for understanding the controls and precautions implemented to ensure your data and that of our members is protected and secure. Please email any questions or concerns to WYproviderservices@cns-inc.com.

Invalid PAs Will Result in Denied Claims in New BMS System

Wyoming Medicaid Providers are reminded to enter the Wyoming Medicaid Prior Authorization (PA) number on the claim, as applicable, when a PA is needed. This is the only data that should be entered specifically in the available PA field on the claim. Providers are also reminded that PA numbers are 10-digits and numeric-only. Therefore, alpha characters are not valid.

If a PA is not required, providers should not enter anything, including "NA" or "No PA required," in the PA field on the claim. This type of entry will result in a denial within the new Benefits Management System and Services (BMS) system. Claims with these type of PA entries will be marked as invalid and denied.

Policy, Billing, and Claims Processing Changes Update

The following are important updates in regard to Wyoming Medicaid policy, billing, and claims processing changes that have been made with the new claims Benefits Management System and Services (BMS).

Nursing Home Hospice PAs

Prior Authorizations (PAs) will no longer be needed for nursing home hospice services. The process for requesting and locking a member into hospice will remain the same. This includes the following:

  • Provide a copy of hospice benefit election form to CNSI and the Wyoming Medicaid Long Term Care (LTC) Unit.
  • Submit physician certification of terminal illness.
  • As of 10/25/2021, a PA number will no longer be required on the claim form, regardless of date of service.

Chiropractic Claims

The policy put in place as of June 1, 2021, remains in effect in regard to chiropractic services only being covered for adults for Medicare crossovers and children under the age of 21 with medical necessity. Wyoming Medicaid will be reviewing these claims for appropriateness and to ensure documentation requirements are being met.

Nursing Home

Previously, Wyoming Medicaid policy required minimal use of value codes (80 and 81). The use of value codes, occurrence codes, and occurrence span codes will be a mandatory requirement as of January 1, 2022. Provider training will be forthcoming in November and December 2021.

Dental PAs

A reminder that Dental Prior Authorization (PA) requests are to be submitted to WYhealth. For questions, please call 1-888-545-1710.

Outpatient Hospital/OPPS

Outpatient hospital claims will be processed through the 3M groupers. Outpatient Prospective Payment System (OPPS) updates will no longer be a quarter behind.

Please continue to watch for updated provider bulletins for any upcoming new Wyoming Medicaid policies, published on the new Wyoming Medicaid website at: https://wyomingmedicaid.com/.

Provider Services is now available at 1-888-WYO-MCAD or 1-888-996-6223.

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