State · WY
Medical billing services in Wyoming
Short answer
Medical billing services in Wyoming deal with a Medicaid program that takes only electronic claims and pays almost everything fee-for-service: CMS counted 202 of the state's 73,053 Medicaid enrollees, 0.3 percent, in any managed care arrangement in 2024, all of them in Magellan's behavioral health Care Management Entity.
The Division of Healthcare Financing must receive a clean claim within 12 months of the date of service, every non-emergency ride is prior authorized through the Customer Service Center, and home health agencies build their claims in the CareBridge EVV system. A Remitwright dedicated biller keeps those rules per payer, serving Wyoming practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Wyoming: what's different
The rules below change how a claim is filed and paid in Wyoming. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Wyoming | Source |
|---|---|---|
| Medicaid program | Wyoming MedicaidWyoming Department of Health, Division of Healthcare Financing | 4 |
| Fee-for-service portal | Wyoming Medicaid Provider Portal (Benefit Management System) | 4 |
| How Medicaid is delivered | Fee-for-service | 6 |
| Managed care plans | 1 planCare Management Entity (Magellan Healthcare of Wyoming) | 7 |
| Medicaid timely filing (fee-for-service) | 12 months (365 days) from the date of service | 2 |
| Prompt-pay law | Wyo. Stat. § 26-15-124, claim to be accepted or rejected | 9 |
| NEMT | No broker | 2 |
Wyoming Medicaid
Wyoming Medicaid is run by the Wyoming Department of Health, Division of Healthcare Financing. Fee-for-service claims and provider enrollment go through the Wyoming Medicaid Provider Portal (Benefit Management System)4, at www.wyomingmedicaid.com. Fee-for-service: CMS counted 202 of Wyoming's 73,053 Medicaid enrollees, 0.3 percent, in any managed care arrangement in 2024, and none in a full-benefit managed care organization6. The 202 are children in the behavioral health Care Management Entity run by Magellan Healthcare of Wyoming; every other claim, medical, dental or institutional, goes to the state's Benefit Management System.
Fee-for-service filing limit: 12 months (365 days) from the date of service for Wyoming Medicaid to receive a clean claim, meaning an error-free, correctly completed claim with all required attachments that can be processed and approved to pay within that period2. A Medicare crossover gets 365 days from the date of service or 180 days from the payment date on the Medicare explanation of benefits, whichever is later; a member found eligible retroactively, on appeal or through agency correction, gets 180 days from the determination with the dated notice attached; and a corrected claim after a records inconsistency goes in with a cover letter citing the policy. A timely filing denial can be appealed only if the claim was first filed and at least one corrected resubmission was attempted within the 365 days, or a Medicaid system or policy problem blocked it; billing errors and third-party liability never extend the limit. There are no managed care plans paying medical claims, so one clock applies to every member.
Managed care plans7
- Care Management Entity (Magellan Healthcare of Wyoming)Behavioral health organization only, voluntary, for children with serious behavioral health needs; 202 members in CMS's 2024 count, and no medical claims
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Wyoming Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Wyoming10: Blue Cross Blue Shield of Wyoming, UnitedHealthcare Insurance Company, Cigna (named in the Wyoming Medicaid CMS-1500 manual as a payer primary to Medicaid). A Wyoming practice works to a separate provider manual for each, with its own filing window, corrected-claim process and appeal levels. Verified payer deadlines, each with its source, are in the timely filing limits table.
Clean-claim payment window under Wyo. Stat. § 26-15-124, claim to be accepted or rejected: 45 days after receipt of the proofs of loss and supporting evidence for a life, accident or health insurance claim to be accepted and paid or rejected9. The 45 days may be exceeded for an accident and health claim whose validity or amount is in question and has been referred to the Wyoming state medical peer review committee, or as W.S. 26-16-112(a) and 26-52-203 allow. Where a court finds an insurer's refusal to pay the full covered amount unreasonable or without cause, it may add a reasonable attorney's fee and interest at 10 percent a year. Where the statute earns its place is A/R follow-up: a clean claim that outlasts the window is escalated with the statute cited, and interest is requested where Wyoming law provides it.
NEMT and home care in Wyoming
Non-emergency medical transportation. No broker: Wyoming Medicaid enrolls taxi providers, non-taxi ride providers and lodging providers directly, and every ride or stay is prior authorized through the Customer Service Center's travel request option before the trip, with the PA number pulled from the Provider Portal onto the claim2. Taxi rides bill A0100 for each one-way trip plus S0215 mileage; non-taxi rides bill A0110 with A0080 for each mile above the 15 included in the base rate; lodging bills A0180 per night for members more than 200 miles round trip from the facility, with exceptions for multi-day appointments, outpatient recovery under supervision, maternity care and long early or late drives. Mileage rounds up, miles without the member on board, wait time and no-shows are not payable, and rides on different dates cannot be span billed. The NEMT billing in Wyoming page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Home health agencies are expected to submit electronically validated visits and generate their claims through CareBridge, the EVV solution the Division of Healthcare Financing provides at no cost, or to integrate their own EVV system with CareBridge3. The EVV system creates the Medicaid claim and sends it to the Benefit Management System; when a commercial payer has denied, the claim posts edit 7141 and is held in process for 30 days for the payer's original EOB. CMS found Wyoming not compliant for personal care EVV on January 4, 2021, with FMAP reductions from the first quarter of 2021, and accepted its home health attestation on December 29, 2023, listing the state as compliant for home health from January 1, 2024. See home care billing in Wyoming for waiver programs, EVV exceptions and authorizations.
Rules that change how Wyoming claims are billed
Wyoming Medicaid takes electronic claims only, and enrollment runs through a separate portal4
The Department of Health's provider page says it plainly: Wyoming Medicaid only accepts electronic claims submissions. Claims are processed by the fiscal agent's Benefits Management System, reached through the provider portal at wyomingmedicaid.com, with Provider Services on 1-888-996-6223 for billing questions. Enrollment is a different system: providers register in the Discover Your Provider portal at wyoming.dyp.cloud, operated for the state by HTG Technology Group, confirm their email, complete the application steps, sign the agreements and upload the W-9 and other financial documentation, after which a provider specialist processes the application and emails the final determination. So a new practice sets up two logins before its first claim, and the enrollment decision arrives by email rather than on the claims portal.
365 days for a clean claim, and an appeal only if you tried to fix it in time2
The Division of Healthcare Financing adheres strictly to its timely filing policy: a clean claim, error free and complete with attachments, must reach Medicaid within 12 months (365 days) of the date of service, and for deliverable items such as dentures, DME, glasses and hearing aids the date of service is the delivery date, not the order date. A timely filing denial is appealable only when the claim was originally filed within the 365 days and is on file, the provider made at least one attempt to resubmit a corrected claim inside the window and documents every TCN and every Provider Services contact in the appeal letter, or a Medicaid computer or policy problem beyond the provider's control prevented finalizing the claim. Timely filing is never waived for provider billing errors or third-party liability, and appeals of correctly denied claims are denied automatically.
Every NEMT ride is prior authorized through the Customer Service Center2
Wyoming Medicaid runs non-emergency medical transportation without a broker: it enrolls taxi providers (taxonomy 344600000X), non-taxi ride providers (347C00000X) and lodging providers (177F00000X). The member, or for non-taxi rides the provider, initiates the trip through the Customer Service Center's travel request option or a travel request form, approval generates a prior authorization number the provider retrieves from the Provider Portal, and the claim carries that number. Taxi rides bill A0100 per one-way trip plus S0215 per mile, non-taxi rides A0110 plus A0080 for each mile above the 15 included in the base rate, a 23.2-mile trip becoming A0110 and nine units of A0080, and lodging A0180 per night with the travel request number in the member account field. Rides are subject to post-payment review, so pick-up time, addresses and total mileage stay on file for each trip.
CareBridge builds the home health claim, and a commercial denial parks it for 30 days3
The institutional manual expects every contracted home health agency to use the CareBridge EVV solution at no cost or to integrate its own EVV system with CareBridge, under the 21st Century Cures Act. Home health claims bill type of bill 32X or 33X under taxonomy 251E00000X, every service needs a Telligen prior authorization requested within 10 business days of the start of care, and the EVV system creates the claim and sends it to the Benefit Management System. When a commercial payer has paid in part or in full, the agency bills the BMS directly with the TPL amounts and adjustment codes on the claim lines and the payer's original EOB attached; when the commercial payer has denied, the claim goes through the EVV system, posts edit 7141 for third-party liability on file, and is held in process for 30 days for the agency to attach the payer's original EOB, which must come from the payer and not from the agency's own EHR, before it is reviewed and processed.
The only managed care is a behavioral health entity for children, and it pays no medical claims8
CMS's 2024 state tables record one Wyoming managed care program, the Behavioral Health Care Management Entity, a behavioral health organization operating statewide under 1915(b) and 1915(c) authority since September 1, 2015 with its waiver running through June 30, 2029. Enrollment is voluntary for children with special health care needs, Native American children and children in foster care or adoption assistance, the covered benefits are case management and targeted case management with family care coordinators, youth peer support partners and family support partners plus respite, and the entity must hold NCQA, Joint Commission, URAC or Council on Accreditation accreditation, with Guidehouse as the external quality review organization. CMS's plan table names Magellan Healthcare of Wyoming as the parent organization, with 202 members in 2024.
Insurers get 45 days to accept and pay or reject a health claim9
Under W.S. 26-15-124(a), claims for benefits under a life, accident or health insurance policy must be rejected, or accepted and paid, within 45 days after the insurer receives the proofs of loss and supporting evidence. The clock pauses only when the validity or amount of an accident and health claim is in question and referred to the Wyoming state medical peer review committee, or as W.S. 26-16-112(a) and 26-52-203 allow. Subsection (c) adds the lever: where an insurer refuses to pay the full amount of a covered loss and a court finds the refusal unreasonable or without cause, the court may award a reasonable attorney's fee and interest at 10 percent a year on top of the judgment, which is why the 45-day date is logged on every Wyoming commercial claim at submission.
Services for Wyoming practices
Remitwright serves Wyoming practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Wyoming practices
What is the Wyoming Medicaid timely filing limit?
Which Medicaid plans do we contract with in Wyoming?
How quickly must insurers in Wyoming pay a clean claim?
Does Wyoming require EVV for home care visits?
How do our Wyoming Medicaid patients get a ride to an appointment?
Where do Wyoming Medicaid fee-for-service claims go?
Which commercial payers did you list for Wyoming, and why those?
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