Office Outpatient Visit Threshold


Wyoming Medicaid has partnered with WYhealth to assist with the review of medical records and to also help members coordinate the services necessary to meet their healthcare needs. For most eligible adult members, Wyoming Medicaid will cover 12 doctor visits each calendar year before requiring medical records to verify the need for additional doctor visits.

When Wyoming Medicaid receives a claim for the 13th doctor visit in the same calendar year, the member will be enrolled in the WYhealth program and will be sent a letter with information about the program. This program is phone-based. If a member chooses not to participate in the WYhealth program, Wyoming Medicaid will not cover the additional doctor’s visits during the same calendar year until information is received from the member’s doctor explaining the medical necessity of continued visits.

Letters will also be sent to the member’s doctor(s) to inform them that the member has been referred to the WYhealth program, and if the member is participating in the program. If members have any questions regarding the WYhealth program, members can call WYhealth directly at 888-545-1710.

Note: Doctor’s visits indicated as emergency or for family planning services will not be subject to this process.