Provider Manuals and Bulletins

Provider Manual updates and Provider Bulletins are published each quarter during the calendar year. Providers are encouraged to review all manual updates and bulletins aligned to the specific provider types and specialties they furnish benefits and services through as a provider in the Wyoming Medicaid program.

This page organizes the full spectrum of provider types and specialties within three (3) claim types: CMS-1500, Dental, and Institutional/UB.

The most recent version of each Provider Manual is available under the "Provider Manual" dropdown. Previous versions can be accessed under "Archives".

To download the entire Provider Manual, select a topic under the heading for your provider type. To access sections of a Provider Manual, use the "Provider Manual" dropdown to open specific chapters of each manual.

Important Medicaid Integrity Information

Medicaid Integrity Program A to Z

Medicaid Integrity Program (MIP), Provider Audits FAQs

Please select the appropriate manual for your provider type.

 
Provider Manuals
CMS-1500 Provider Manual

Chapter 1 – General Information

Chapter 2 – Getting Help When Needed

Chapter 3 – Provider Responsibilities

Chapter 4 – Utilization Review

Chapter 5 – Member Eligibility

Chapter 6 – Common Billing Information

Chapter 7 – Third Party Liability

Chapter 8 – Electronic Data Interchange and Provider Portal

Chapter 9 – Important Information

Chapter 10 – Covered Services – Ambulance

Chapter 11 – Covered Services - Audiology

Chapter 12 – Covered Services – Behavioral Health

Chapter 13 – Covered Services – Care Management Entity and Children’s Mental Health Waiver Services

Chapter 14 – Covered Services – Chiropractic Services

Chapter 15 – Covered Services – Clubhouse Services

Chapter 16 – Covered Services – Developmental Centers

Chapter 17 – Covered Services – Dietitian Services

Chapter 18 – Covered Services – Durable Medical Equipment Billing

Chapter 19 – Covered Services – Family Planning

Chapter 20 – Covered Services – Health Check

Chapter 21 – Covered Services – Interpreter Services

Chapter 22 – Covered Services – Laboratory Services

Chapter 23 – Covered Services – Non-Emergency Medical Transportation

Chapter 24 – Covered Services – Practitioner Services

Chapter 25 – Covered Services – Pregnant by Choice

Chapter 26 – Covered Services – Therapy Services

Behavioral Health Centers Provider Manual

Introduction

Background

Rules

Eligible Providers

Provider’s role

Recipient Eligibility

Priority Populations

Fee Schedules

Payment Policies and Billing

Telehealth Services

Prior Authorization (PA)

Quality Assurance

Covered Services

Treating Providers

List of Modifiers

Resources

Dental Provider Manual

Chapter 1 – General Information

Chapter 2 – Getting Help When Needed

Chapter 3 – Provider Responsibilities

Chapter 4 – Utilization Review

Chapter 5 – Member Eligibility

Chapter 6 – Common Billing Information

Chapter 7 – Third Party Liability

Chapter 8 – Electronic Data Interchange

Chapter 9 – Important Information

Chapter 10 – Covered Services

Institutional Provider Manual

Chapter 1 – General Information

Chapter 2 – Getting Help When Needed

Chapter 3 – Provider Responsibilities

Chapter 4 – Utilization Review

Chapter 5 – Member Eligibility

Chapter 6 – Common Billing Information

Chapter 7 – Third Party Liability

Chapter 8 – Electronic Data Interchange

Chapter 9 – Important Information

Chapter 10 – Outpatient Services

Chapter 11 – Critical Access Hospital and General Hospital Inpatient

Chapter 12 – Comprehensive Outpatient Rehabilitation Facility

Chapter 13 – End Stage Renal Disease

Chapter 14 – Federally Qualified Health Centers

Chapter 15 – Home Health

Chapter 16 – Hospice

Chapter 17 – Indian Health Services

Chapter 18 – Skilled Nursing Facility and Swing Bed Services

Chapter 19 – Rural Health Clinics

Chapter 20 – Psychiatric Residential Treatment Facility

School Based Services Provider Manual

Chapter 1 – General Information

Chapter 2 – Steps to Becoming a School-Based Services Program Provider

Chapter 3 – Billing for Medical Services

Chapter 4 – Covered Services and Qualified Providers

Chapter 5 – Programmatic Expectations

Title 25 Provider Manual

Chapter 1 – General Information

Chapter 2 – Getting Help When Needed

Chapter 3 – Provider Responsibilities

Chapter 4 – Common Billing Information

Chapter 5 – Third Party Liability

Chapter 6 – Important Information

Chapter 7 – Critical Access Hospital and General Hospital Inpatient

Chapter 8 – Covered Services – Ambulance

Chapter 9 – Covered Services – Non-Emergency Medical Transportation

Behavioral Health Centers Manual and Bulletins

Behavioral Health

CMS 1500 Manual and Bulletins

Ambulance Services

Developmental Centers

DME

Family Planning Clinics

Hearing Services

Laboratory Services

Behavioral Health

Nurse Practitioner

Physical Therapy

Physician Services

School Based Services Program

Vision Services

Waiver

Dental General Manual, Covered Services and Bulletins

Dental

Institutional / UB Manual and Bulletins

Ambulatory Surgical Center

Comprehensive Outpatient Rehabilitation Facility

Critical Access Hospital

End Stage Renal Disease

Extraordinary Care

Federally Qualified Health Centers

Home Health

Hospice

Hospital Services

Indian Health Services

Nursing Home

Outpatient Services

Rural Health Clinics

Swing Bed Services

School Based Services Manual and Bulletins

School Based Services Manual (Effective 10.1.25)

School-Based Services - Wyoming Medicaid

Wyoming Medicaid EDI Companion Guide

Wyoming Medicaid EDI Companion Guide