NEMT billing in Wyoming

No broker. Wyoming Medicaid provides non-emergency medical transportation to members who need help traveling to and from appointments with enrolled providers, and it enrolls three provider types to deliver it: taxi providers under taxonomy 344600000X, non-taxi ride providers under 347C00000X and lodging providers under 177F00000X. For a taxi ride the member starts the request by calling the Customer Service Center and choosing the travel request option; for a non-taxi ride the member or the provider may start it the same way or with a travel request form, and where the member asked for the ride the member contacts the ride provider once it is approved. Approval generates a prior authorization number, and the provider retrieves it from the Provider Portal for the claim.¹ Lodging is requested the same way for a member who lives more than 200 miles round trip from the medical facility, with exceptions for several appointments over several days, direct medical supervision during outpatient recovery, medically necessary maternity services, and a trip of more than 100 miles one way that would not get the member home before 8:00 p.m. or would require leaving before 6:30 a.m.

Medicaid provider enrollment in Wyoming runs through the Discover Your Provider (DyP) enrollment portal². Wyoming has no NEMT broker: taxi, non-taxi ride and lodging providers enroll with Wyoming Medicaid and bill the state's Benefit Management System for rides the Customer Service Center approved in advance¹.

The Department of Health's provider page lays out six steps that begin with registering on the Discover Your Provider (DyP) enrollment portal and end when a provider specialist processes the application and emails the determination. HHS Technology Group runs provider enrollment for Wyoming Medicaid, the Department contracts a fiscal agent to operate the Benefit Management System, and Wyoming Medicaid accepts only electronic claims.² The CMS-1500 manual, prepared by the fiscal agent Acentra Health, adds the rules that keep an enrollment alive: all providers complete the online application on the HHS Technology Group site, a provider that submits no claim within fifteen months may be terminated for inactivity and must enroll again, and every provider completes a new application, a screening and a signed Provider Agreement at least every five years, with HHS Technology Group giving notice before any re-enrollment termination.

• Prior authorization for the ride, and the PA number on the claimTaxi and non-taxi rides are billed with the PA number associated with the ride; the provider retrieves it through the Provider Portal's prior authorization status inquiry.
• Member information, including the Medicaid member IDA lodging provider also needs the Travel Request number, which goes in the member's account number field on the claim.
• Date and time of pick-up, the pick-up address and the destination address
• Total mileage and total chargeMileage counts only with the member on board and is always rounded up, so 5.2 miles bills as 6. A non-taxi ride bills A0080 only for miles above the 15 included in the base rate.
• For lodging, the facility the member attended, inpatient or outpatient status, dates of stay, total nights and total chargeThe member's family needs a copy of the receipt or documentation to receive their per diem for the stay.
• A separate claim line for each date of serviceWyoming does not allow span billing of rides, and all rides and lodging claims are subject to post-payment review, so the detail is kept for every line.

Taxi rides bill A0100 as the base rate, 1 unit per one-way trip, with S0215 for each mile or part of a mile. Non-taxi rides bill A0110 as the base rate, 1 unit per one-way trip, with A0080 for each mile or part of a mile above 15: the manual's example bills a 23.2-mile trip as A0110 for 1 unit and A0080 for 9 units, because the 8.2 miles past the base round up to 9. Lodging bills A0180 for each night, with the manual's condition that a child member be an inpatient at the medical facility or an outpatient staying with the lodging provider.¹ Wait time, no-shows and late members are not covered services, though no-shows should be reported to Provider Services, and mileage without the member on board is not billable. These are professional claims under the CMS-1500 manual, and Wyoming Medicaid takes them only electronically, by direct data entry in the Provider Portal or as an electronic transaction file. Plain-language explanations of the transport codes and the origin and destination modifiers are on the NEMT billing codes page.

12 months, 365 days, from the date of service for a clean claim to reach Wyoming Medicaid. A clean claim is error free, correctly completed, carries every required attachment and can be processed and approved to pay inside that period, and the Division of Healthcare Financing says it adheres strictly to the policy.¹ Exceptions beyond the provider's control: a Medicare crossover has 365 days from the date of service or 180 days from the payment date on the Explanation of Medicare Benefits, whichever is later; a member found eligible retroactively on appeal, reconsideration, court decision or agency correction gives the provider 180 days from the determination, with the dated notice attached and a cover letter requesting the exception; and a corrected claim after a provider finds its records inconsistent with a filed claim goes in promptly with a cover letter citing the policy.