Wyoming Medical Billing and Payer Rules

Timely Filing in Wyoming Medical Billing and Payer Rules

Wyoming Medical Billing and Payer Rules Surprise Billing vs the Federal NSA

Major Payers

How Does Wyoming Medicaid Billing Work?

Wyoming Medicaid is run by the Division of Healthcare Financing (DHCF), which administers the program for the Wyoming Department of Health (WDH). DHCF sets policy, benefit limits, payment methods and fees, and does utilization review.

That contractor is Acentra Health, the fiscal agent for Wyoming Medicaid. It processes claims and adjustments, answers provider questions on claim status, eligibility and known third party insurance, and trains billing offices.

Your billing rules live in the Acentra Health provider manuals. We read the BMS Institutional Provider Manual dated October 1, 2026 (version 20.0). It says DHCF policy overrides Medicare policy where the two disagree, and that not every code Medicare covers is covered by Medicaid.

Provider Services is the first call for claim problems: 1-888-996-6223 (also written 1-888-WYO-MCAD), Monday to Friday, 7 am to 6 pm Mountain time.

What Is WINGS, and Does It Change How Wyoming Medicaid Claims Are Processed?

WINGS is the Wyoming Integrated Next Generation System, the state's plan to replace the current Wyoming Medicaid Management Information System (WY-MMIS).

The Wyoming Medicaid pages cited here publish no cutover date for the claims module. Until a notice says otherwise, treat the October 2026 manuals as the rules in force. Revisions are published quarterly.

Does Wyoming Medicaid Accept Paper Claims?

No, with narrow exceptions. The institutional manual says all original claims to Wyoming Medicaid must be filed electronically and that Acentra Health will not accept paper claims for any Medicaid service. Every claim also needs taxonomy codes for the billing, attending, servicing and rendering providers.

The exceptions are narrow: providers with a Letter of Agreement (LOA) with WDH follow the LOA, certain nursing home DME out-of-policy items may bill on paper, and providers working with WDH or Acentra Health on special batch claims may continue to.

The secure Provider Portal handles claim submission, claim status, eligibility, prior authorization inquiry, electronic attachments and remittance advice. Multifactor authentication is required for all providers.

Per the Wyoming Medicaid FAQ, claims are processed on Wednesday evening, EFTs are generated Thursday and remittance advices are available Friday.

What Is the Wyoming Medicaid Timely Filing Limit?

Wyoming Medicaid requires a clean claim within 12 months (365 days) of the date of service. The institutional manual, section 6.19, says DHCF adheres strictly to this policy. A clean claim is an error-free, correctly completed claim with all required attachments that will process and approve to pay inside that window.

A claim rejected for a missing attending NPI on day 360 gives you five days, not a fresh year. For deliverable items such as DME, the date of service is the delivery date.

First, the Wyoming Medicaid provider FAQ words the adjustment limit as six months from the date of service, while the manual says six months from the date of payment. Use the manual, and when the two differ, ask Provider Services to confirm in writing. Voids are accepted at any time without timely filing limits, according to the FAQ.

Overpayment adjustments are accepted indefinitely, but the Provider Agreement requires you to notify Medicaid within 30 days of learning of one.

A timely filing denial can be appealed only in narrow cases. Under section 6.19.2, the claim must have been originally filed within 12 months of the date of service and be on file, you must have made at least one attempt to resubmit a corrected claim inside the 12 months, and your appeal letter must document all claim history including TCNs and every contact with Provider Services. Use the First Level Appeal and Grievance Request Form. The manual warns that appeals for claims that denied correctly are denied automatically.

How Do I Enroll with Wyoming Medicaid, and How Often Do I Revalidate?

Wyoming Medicaid pays only providers who are actively enrolled. You complete the online enrollment application on the website of HHS Technology Group, the enrollment vendor, which can be reached at 877-399-0121, Monday to Friday, 8 am to 5 pm Mountain time. Address, phone and email changes also go through that vendor as a Change of Circumstance.

Enrollment includes a screening process and a signed Provider Agreement at least every five years, and the requirement applies to in-state and out-of-state providers. Providers enrolled in Medicare, another state's Medicaid or CHIP pay only one enrollment fee.

Backdating needs an appeal: a letter with proof of enrollment in Medicare or another state's Medicaid covering the requested dates.

Ordering, referring and prescribing providers and attending providers must also be enrolled, even if they never bill Wyoming Medicaid. The manual also says a provider is terminated after 12 months with no paid claims on file, except providers enrolled only as ordering, referring or prescribing.

How Should a Wyoming Hospital Bill UB-04 Claims to Wyoming Medicaid?

Hospitals bill Wyoming Medicaid on the UB-04 in its electronic 837 Institutional form, and professional services on the CMS-1500 (837P). The manual pairs each bill type with a pay-to provider taxonomy,, so check that pairing first on a rejected claim.

Payment methods depend on the setting. Inpatient claims are priced with APR-DRG grouping, and outpatient claims for critical access hospitals, children's hospitals, general hospitals and ambulatory surgical centers follow the OPPS methodology, which the manual describes as based on Medicare's program.

Several UB-04 details are specific to Wyoming. The complete 10-digit prior authorization number goes in field 63. Present on Admission indicators are required on inpatient claims for all hospital types, and Wyoming has adopted Medicare's list of exempt ICD-10 diagnosis codes. The state must deny payment for provider preventable conditions in inpatient hospital settings.

Care Management Entity services that need prior authorization go through Magellan Healthcare (307-459-6162, per the manual's quick reference). The online fee schedule shows whether a procedure code needs prior authorization.

When Medicare or another payer is primary, the manual is exact. Crossover lines on your Medicaid claim must match the claim sent to Medicare, except where Medicare denied, and you enter the CARC, RARC and group codes from the Medicare explanation of benefits. If Medicaid has not paid 45 days after the Medicare payment, submit the claim to Medicaid with the coordination of benefits information. Our hospital and facility billing work covers these steps for institutional claims.

Who Is the Medicare MAC for Wyoming?

Noridian Healthcare Solutions, LLC is the A/B Medicare Administrative Contractor for Wyoming, in Jurisdiction F. The CMS list of MACs by state shows Jurisdiction F covering Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming.

Home health and hospice claims are the exception. The CMS list places Wyoming in the home health and hospice area of Jurisdiction 15, where the MAC is CGS Administrators, LLC.

Medicare timely filing is one calendar year under 42 CFR 424.44(a)(1). Wyoming shares Noridian Jurisdiction F with Montana and Utah. Colorado to the south is Jurisdiction H under Novitas Solutions, a different contractor. See our Medicare payer guide.

What Is the Wyoming Prompt Pay Law for Insurers?

Wyoming Statute 26-15-124(a) requires an insurer to reject or accept and pay a life, accident or health claim within 45 days after it receives proofs of loss and supporting evidence. The text is reproduced in Enrolled Act 59 (Senate File 0100, 2024), which amended the subsection, so that is the version cited.

The 45 days has exceptions. The statute allows more time for accident and health claims where there is a question about the validity or amount of the claim and the question is referred to the Wyoming state medical peer review committee. It also points to exceptions under W.S. 26-16-112(a) and 26-52-203. The clock counts from proofs of loss and supporting evidence, so incomplete documentation lets a plan say it has not started.

Pharmacy claims have their own faster rule. W.S. 26-52-203, created by the same 2024 act, requires contracts between an insurer or its intermediary and a pharmacy to pay clean claims within 21 days for electronic claims and 30 days for other claims. Late payment carries interest at 18 percent per annum, billed weekly.

This page does not state the interest and attorney fee language in subsection (c) of 26-15-124, so read it in the statute. If a health plan sits on a claim past 45 days, record when the proofs of loss arrived and call the Wyoming Department of Insurance Consumer Affairs section at 307-777-7402. Other states are in our state billing rules hub.

Does Wyoming Have Its Own Surprise Billing Law?

Not one that sets the out-of-network payment rate. In its December 9, 2021 letter to Governor Gordon and Commissioner Rude, CMS wrote that Wyoming has no All-Payer Model Agreement and did not identify in its survey any state law governing the out-of-network rate. The federal IDR process under 45 CFR 149.510 and 149.520 therefore applies to insured group and individual coverage in Wyoming.

The same letter says something unusual about enforcement. CMS understood that Wyoming lacks authority to enforce many No Surprises Act provisions, and CMS said it would directly enforce them in Wyoming. That letter is dated 2021, and no newer document changing it is cited here. Our state surprise billing law guide compares the states.

In practice, the dispute path for an insured out-of-network emergency or facility-based claim in Wyoming looks like this.

1. Receive the initial payment or denial from the plan.
2. Send the open negotiation notice. Under 45 CFR 149.510(b)(1), open negotiation runs for 30 business days.
3. If the claim is still unresolved, submit the IDR initiation notice within 4 business days after open negotiation ends.
4. Track entity selection, fees and offer deadlines, then confirm the plan pays the award.

The letter also says the federal patient-provider dispute resolution process applies in Wyoming for uninsured and self-pay patients who are billed substantially more than their good faith estimate, with 120 calendar days from the initial bill to start. Our out-of-network billing and IDR team works these deadlines, and emergency groups can read the emergency medicine billing page.

Denials for medical necessity have their own state route. The Wyoming Department of Insurance says that after a patient exhausts the carrier's internal appeals, they have 120 days from the final denial letter to request an independent external review under W.S. 26-40-201 and Insurance Department Rules, Chapter 63. The independent review organization must decide a standard review within 45 days and an urgent review within 72 hours.

Which Payers Matter Most for a Wyoming Hospital or ER Group?

Two payers we can document from official sources are Medicare, through Noridian Healthcare Solutions, and Wyoming Medicaid, through Acentra Health.

This page cites no Wyoming Department of Insurance market share report or Medicaid managed care plan list, so we name no commercial or Medicare Advantage plan here. The Medicaid manuals describe fee-for-service claims through the fiscal agent. Build your payer list from your own remittance data and confirm each plan's windows in its provider manual.

State law such as W.S. 26-15-124 reaches fully insured plans regulated by the Wyoming Department of Insurance, while a self-funded plan under ERISA is outside that department's authority, which is why contract terms and the federal process carry more weight there. For Medicaid across states, see our Medicaid payer guide.

How Do We Handle Billing in Wyoming?

We work the Wyoming rules above as account controls: a 365-day Medicaid clock on every claim, a separate 180-day clock on crossovers and adjustments, electronic-only submission through the Provider Portal, and a 45-day check on every commercial claim. Claims are sent within 24 hours of charge entry, and denials are worked within 48 hours.

Because CMS enforces the No Surprises Act in Wyoming, we track open negotiation and federal IDR deadlines for each out-of-network claim. If you want a Wyoming review of your Medicaid, Medicare and commercial A/R, book a call.