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Wyoming Medicaid


Our work advances healthcare and improves health for people in Wyoming through our expertise in utilization management review, in partnership with Wyoming Medicaid.

We are staffed by qualified healthcare professionals who provide utilization management tailored to the needs of enrolled Wyoming residents. We are privileged to perform this vital work.


Services We Provide for Wyoming Medicaid

  • Utilization management of durable medical equipment and home health services
    • Prior authorization review
    • Retrospective review


Announcements

Please check this page regularly for updates.

November 10, 2017: Recording of November 2 Webinar Now Online
If you couldn’t make it to the November 2nd “Post-launch Q&A” webinar or if you’d like to watch it again, the recording is now available on the Provider Education page.

November 2, 2017: Reminder: New Prior Authorization Code List in Effect
We have updated the prior authorization code list. This new document, Codes Requiring Authorization List, went into effect on November 1. You can also find a link to it on the Provider Resources page under the heading “Prior Authorization Materials.”.

October 20, 2017: Recordings Available for October 10th and October 12th Webinars
Recordings of the October 10th “Requesting a Therapy Review” webinar and the October 12th “Requesting an Outpatient Behavioral Health Review” webinar are now available on the Provider Education page.

October 6, 2017: Webinar Recordings & Slides Available
We have held three webinars to prepare therapy (PT/OT/ST) and outpatient behavioral health providers for prior authorization review:

  • Registering for the Qualis Health Provider Portal
  • Requesting a Therapy Review
  • Requesting an Outpatient Behavioral Health Review


You can find videos and slides for these sessions on the Provider Education page in the “Webinar Archives” section.

We are offering “Requesting a Therapy Review” and “Requesting an Outpatient Behavioral Health Review” again next week. The “Post-launch Q&A” webinar will be on November 2nd. Register for any of these events on the Provider Education page.

October 4, 2017: Coming Soon: Updated Prior Authorization List
Beginning November 1, 2017, please use the updated Codes Requiring Prior Authorization list. Continue using the current HCPCS Codes and Home Health Procedure Codes Requiring Prior Authorization list through October 31, 2017.

September 1, 2017: Prior Authorization Review for Behavioral Health and Therapy Services Begins November 1
Effective with dates of service November 1, 2017, Qualis Health will perform prior authorization reviews for outpatient behavioral health and physical, occupational, and speech therapy services. Please see the Wyoming Medicaid provider bulletin for more about this policy change.

We will be holding webinars to show you how to use the Qualis Health Provider Portal, our online system for submitting review requests. Visit the Provider Education page for webinar dates, times and registration information.

February 24, 2017: Home Health Services Review Begins March 1
Beginning March 1, Qualis Health will begin performing reviews for home health services. All home health services will require prior authorization.

  • For details on this change, including instructions for submitting reviews, view the February 22nd training webinar slides or recording (also located on the Provider Education page in the “Archives” section).
  • Find the list of HCPCS Codes and Home Health Procedure Codes Requiring Prior Authorization on the Provider Resources page in the “Prior Authorization Materials” section.


January 20, 2017: DME Prior Authorization Form Now on the Provider Resources Page
You can now download the Wyoming Medicaid DME Medical Supplies & Equipment Prior Authorization Request Form from Qualis Health’s website. Find it on the Provider Resources page in the “Prior Authorization Materials” section.

December 6, 2016: Materials from November Webinar Now Available
Thank you for attending our November 30 webinar! The slides and recording from this session are now available. Links to both files are on the Provider Education page in the “Archives” section.

Correction: Upgrade to 2016 Version of InterQual Criteria Effective December 15
Beginning December 15, 2016, Qualis Health will review DME prior authorization requests using the 2016 version of McKesson’s InterQual Criteria. For items not covered by InterQual Criteria, we will continue to use the Medical Supplies and Equipment Covered Services and Limitations Module. A previous version of this announcement listed the effective date as December 1.

 

 

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Contact Us

Phone:
(800) 783-8606

Fax:
(877) 810-9265

»Qualis Health Provider Portal

Contact Wyoming Medicaid

Amy Buxton
Provider Services Manager
Wyoming Medicaid
Department of Health
Division of Healthcare Financing
Phone: (307) 777-5081
Fax: (307) 777-6964
amy.buxton@wyo.gov

wymedicaid.acs-inc.com


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