Wyoming Medicaid helps pay for healthcare services for children, pregnant women, families with children, and individuals who are aged, blind, or disabled who qualify based on citizenship, residency, family income, and sometimes resources and healthcare needs.

Division of Healthcare Financing (DHCF) serves as the State Agency that oversees the Wyoming Medicaid program for the Wyoming Department of Health (WDH).

Acentra Health serves as the Fiscal Agent overseeing specifically the Benefit Management System and Services (BMS) portion of Wyoming Medicaid.

BMS is one of the critical modules of the new Wyoming Integrated Next Generation System (WINGS). WINGS involves both system and service-based components as well as modules that together will replace the current Wyoming Medicaid Management Information System (WY-MMIS).

Both DHCF/WDH (State Agency) and Acentra Health (Fiscal Agent) each have specific responsibilities associated with their roles within Wyoming Medicaid. These roles and responsibilities are as follows:

State Agency Responsibilities

DHCF administers the Wyoming Medicaid program for WDH. They are responsible for financial management, developing policy, establishing benefit limitations, payment methodologies and fees, and performing utilization review.

Fiscal Agent Responsibilities

Acentra Health, as the Fiscal Agent for Wyoming Medicaid, processes all claims and adjustments. Acentra Health also answers provider inquiries regarding claim status, payments, member eligibility, and known third party insurance information. They provide on-site visits to train and assist providers regarding Wyoming Medicaid billing procedures and/or to resolve claims payment issues. They also answer member inquiries regarding eligibility, benefits, Wyoming Medicaid Member ID Cards, and the Transportation Program.