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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


Please check this page regularly for updates.

July 31, 2018: Behavioral Health Review Guidelines Webinar Recordings & Slides Online
We recently held training sessions on the new Wyoming Medicaid behavioral health review guidelines. If you weren’t able to attend, you can watch the webinar recordings or download the slides on our Provider Education page.

July 13, 2018: Register for Behavioral Health Review Guidelines Training
As of July 1, 2018, Qualis Health is following new guidelines for Wyoming Medicaid behavioral health reviews. Join us at one of three online sessions to get in-depth training on these new guidelines. Webinars are on July 23, July 26, and July 27. Registration is required—sign up today!

June 26, 2018: Just Released—Guidelines for Outpatient Behavioral Health Reviews
A new document is now available that covers the guidelines for behavioral health reviews performed by Qualis Health. Download it now.

June 25, 2018: Revised Maintenance Therapy Guidelines Available
The Maintenance Therapy (PT, OT, ST) Review Guidelines have been updated. You can also find this document on the Provider Resources page under the header “Prior Authorization Materials.”

June 4, 2018: Prior Authorization Code List Updated
We have updated the Codes Requiring Prior Authorization document. You can also find a link to this file on the Provider Resources page under the heading “Prior Authorization Materials.”

December 22, 2017: New Resource for PT/OT/ST Providers
We have created a new document to help physical therapy, occupational therapy and speech therapy providers understand the criteria for maintenance therapy reviews. Maintenance Therapy (PT, OT, ST) Review Guidelines contains definitions, examples and answers to frequently asked questions. Find it on the Provider Resources page in the “Prior Authorization Materials” section.

December 6, 2017: DME Provider Manual Updated
The Medical Supplies And Equipment Covered Services And Limitations Module has been updated. You can also find a link to this document on the Provider Resources page under “Provider Manual.”

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 Prior 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.



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Contact Us

(800) 783-8606

(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


»more contact info