COVID-19 Information

 

Please see below to learn about the Wyoming Medicaid response to COVID-19 and find the latest program guidance.

Additional information will be added as it becomes available.

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PASRR Requirement for NH & Swing Bed Providers

In an effort to eliminate any barriers to care that might exist in relation to the COVID-19 virus, Wyoming Medicaid is temporarily suspending the requirement for PASRR Level I and PASRR Level II for thirty (30) days. All new admissions may be treated like exempted hospital discharges. After 30 days, new admissions with mental illness or intellectual disability should receive a PASRR Level I and PASRR Level II, if required.

For the safety of the clients and staff, the PASRR Level II can be conducted remotely by telehealth or telephonically. Please make sure the individual remains directly involved in the evaluation process to the fullest extent.

See the below bulletins for additional information:

Additional updates to Nursing Home and Swing Bed PASRR Requirements 4.8.20

REVISED Nursing Facilities COVID-19 PASRR 3.31.20

Nursing Facility COVID-19 PASRR Changes 3.27.20

Telehealth Changes for COVID-19

Any services that are clinically appropriate may be billed via Telehealth. Be sure to mark the emergency indicator for any COVID-19 services.

The GT Modifier is not an allowed outpatient modifier for claims processing through OPPS. Refer to Section 11.16.10 Modifiers, within the Institutional/UB Provider Manual for more information.

For additional information and billing instructions refer to Chapter 6 Section 24 (Telehealth 6.24).

See below bulletins for additional information

Home Health COVID-19 Telehealth 4.1.20

FQHC/RHC Tribal Facilities Telehealth 3.20.20

BH Peer Specialist via Telehealth 3.20.20

BH Group Therapy via Telehealth 3.18.20

Additional Resources

AAP Guidance

AAFP Guidance

Billing Information

Codes

  • 87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) (Coronavirus Disease [COVID-19]), amplified probe technique: valid for dates of service beginning 3/13/2020.
  • 90471- Immunization Administration; 1 Vaccine (Single or combination vaccine/toxoid)
  • 90472- Immunization Administration; Each additional vaccine. To be listed separately in addition to code for primary procedure.
  • 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
  • 91301- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use
  • 91306 - Moderna Low Dose COVID Vaccine - SARSCOV2 VAC 50MCG/0.25ML IM
  • 91307 - Pfizer COVID Vaccine-Pediatric - SARSCOV2 VAC 10 MCG TRS-SUCR
  • 99000 - Handling and/or conveyance of specimen for transfer from the office to a laboratory. This code is now open to all provider types.
  • 99600 - Home visit NOS: valid for Ambulance taxonomies for the duration of National and State Public Health Emergency declarations.
  • 0001A - Pfizer-Biontech COVID-19 Vaccine Administration - First Dose
  • 0002A - Pfizer-Biontech COVID-19 Vaccine Administration - Second Dose
  • 0003A - Pfizer Third Dose - ADM SARSCOV2 30MCG/0.3ML 3RD
  • 0004A - Pfizer Booster - ADM SARSCOV2 30MCG/0.3ML BST
  • 0011A - Moderna COVID-19 Vaccine Administration - First Dose
  • 0012A - Moderna COVID-19 Vaccine Administration - Second Dose
  • 0013A - Moderna Third Dose - ADM SARSCOV2 100MCG/0.5ML 3RD
  • 0021A - AstraZeneca COVID-19 Vaccine Administration - First Dose
  • 0022A - AstraZeneca COVID-19 Vaccine Administration - Second Dose
  • 0031A - Janssen COVID-19 Vaccine Administration
  • 0034A - Janssen Booster - ADM SARSCOV2 VAC AD26 .5ML B
  • 0064A - Moderna Low Dose Booster - ADM SARSCOV2 50MCG/0.25ML BST
  • 0071A - Pfizer Pediatric 1st Dose - ADM SARSCV2 10MCG TRS-SUCR 1
  • 0072A - Pfizer Pediatric 2nd Dose - ADM SARSCV2 10MCG TRS-SUCR 2
  • A0998 - Treat and Release: valid for Ambulance taxonomies for the duration of National and State Public Health Emergency declarations.
  • G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS - CoV-2) (Coronavirus disease [COVID-19]), any specimen source
  • G2024 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS - CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source
  • U0001 - CDC 2019-Novel Coronavirus Real-Time RT-PCR diagnostic panel: Valid for dates of service beginning 2/4/2020.
  • U0002 - Non CDC Laboratory tests for COVID-19:valid dates of service beginning 2/4/2020.
  • U0003 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput probe technologies as described by CMS-2020-01-R
  • U0004 - 2019-n-CoV Coronavirus, SARs-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R
  • U0005 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome conornaviruse.  An add-on reimbursement to U0003 and U0004 and should only be billed if the test result is:
    • Returned within 2 calendar days of the specimen being collected, and
    • A majority of the laboratory's high throughput tests in the previous calendar month were completed within 2 calendar days from specimen collection 
  • U07.1 - COVID-19 DX code: valid for dates of service beginning 4/1/2020.

Policy Exceptions

  • Ambulance covered services will be extended to transportation of a patient, regardless of their COVID-19 status, to a location other than the most appropriate or closest hospital in order to prevent overloading of a hospital or due to excess patient census.

Prior Authorization Changes

  • Rental Ventilator PA Requirement will be suspended for dates of service beginning 3.1.20. Codes effected:
    • E0466
    • E0470
    • E0471
    • E0472
    • E0481
  • Home Health PA requirement suspended effective 3/17/2020 - 11/30/2020. Per the Home Health and DME Prior Authorization Requirement Reinstatement bulletin below this exception ended for 12/1/2020 and forward dates of service.
  • Change Healthcare has created a new electronic prior authorization submission portal for pharmacy prior authorization submission. This portal can be found under the Prescriber Information tab at http://www.wymedicaid.org/

See below bulletins for additional information

Home Health & DME Prior Authorization Requirement Reinstatement

COVID-19 Flier for Wyoming 4.28.20

Pharmacy Electronic PA Submission 4.4.20

Home Health Removal of PA 3.18.20

COVID-19 Testing Codes RA Banner

COVID-19 Ambulance Changes 3.27.20

Provider Enrollment/Re-Enrollment Exceptions

Wyoming Medicaid recognizes the importance of supporting its providers and has made the following process changes, which will remain in effect through the COVID-19 emergency. The goal of Medicaid is to make and keep providers active during this hectic time to allow providers and their offices to focus on providing services to Wyoming residents.

Medicaid's initiative requiring all current active providers to receive electronic bank transfers (EFT) by April 1, 2020 is still a mandate but providers will remain active if they do not meet the date.

Medicaid is diligently working on making the necessary updates to the provider files impacted by the COVID-19 exceptions outlined below. We anticipate in having all the files updated no later than 4/6/2020, at that time providers may resubmit any denied claims meeting the criteria.

EFT remains a requirement for all new enrolling providers. To protect providers/vendors the State Auditor's Office (SAO) requirements for electronic funds transfer (EFT) remain the same:

Wyoming Medicaid Provider Enrollment email address is: WYEnrollmentSvcs@HHSTechGroup.com

  1. Medicaid will be updating inactive providers to active, if they became inactive between the dates of 1/1/2020 to current for one of the following reasons:
  2. Provider failed to provide Medicaid with their current Medicare certification (inactive status of B)
  3. Provider failed to provide Medicaid with their current license or certification (inactive status of D)
  4. Provider has not had any paid or denied claims within the last 15 months (inactive status of J)
  5. CLIA Licenses with the end date from 1/1/2020 to 9/30/2020 will have their end dates extended to avoid claim denials.
    • Letters will still be mailed and providers are encouraged to email their updated licenses when they are able
  6. Enrollment and & Re-enrollment temporary policy changes
    • Any provider that became inactive due to not completing the re-enrollment application between the dates of 1/1/2020 to current will be made active
    • Re-enrollment letters will continue to be mailed but providers will remain in an active enrollment status and will not be terminated
    • Enrollment/Re-enrollment supporting documentation changes Copies/scanned images/faxes/emails/electronic signatures for the following documents will be accepted at this time:
    • Provider Enrollment Certification
    • HealthCare Provider Agreement (blue ink requirement is temporarily waived)
    • W9 Form - copy is accepted, but must have an original signature, electronic signatures are not accepted.
    • EFT requires one (1) of the following:
      • A voided check
      • Original bank letter
    • Visit the SAO website for the W9 Form and any additional questions, https://sao.wyo.gov/covid-19/
Resources

Wyoming Department of Health EUR Webinar

Cares Act Funding for Mental Health and Substance Abuse Services

CMS New Nursing Home Resource Center

AAP Critical Updates

AAP Telehealth Guidance

CDC Recommended Child & Adolescent Immunization Schedule

AAFP Telehealth Guidance

CDC Vaccine Storage & Handling Toolkit

CMS Information and Guidance Medicaid Postcard

Wyoming Medicaid 1135 Waiver Approval Letter

Provider Relief Fund Health and Human Services Press Release

Health and Human Services sent out a press release late Friday, July 31st related to the Provider Relief Fund.  HHS is announcing an application deadline extension until August 28, for the Medicaid/CHIP and dentist distribution from the funds.  Additionally, starting the week of August 10, HHS will give providers who received funds directly from the Phase 1 Medicare distribution a second opportunity to apply for funding from the Medicaid/CHIP and dentist distribution to allow those providers to access funding up to 2% of annual patient revenue.

See the full press release here https://www.hhs.gov/about/news/2020/07/31/hhs-extends-application-deadline-for-medicaid-providers-and-plans-to-reopen-portal-to-certain-medicare-providers.html

HHS Additional Relief Fund Distribution Clinicians that participate in State Medicaid who have not yet received funding may submit their annual patient revenue information to the Medicaid and Chip Targeted Distribution Provider Relief Fund Payment Portal. This funding will supply relief to Medicaid providers experiencing lost revenue or increased expense due to COVID-19. Refer to the complete notification for the complete details and requirements.