By Wyoming Department of Health
With implementation of ICD-10 now in the state’s rear view, for the time being, Wyoming Medicaid is intensely focused on the second of its three major provider initiatives – mandatory re-enrollment. Based on a provision included in the 2010 Patient Protection and Affordable Care Act (ACA), Medicaid programs across the country have been required to implement enhanced provider screening and enrollment processes.
To complete the re-enrollment process, click here:
With the administrative and state-level process enhancements in place, Wyoming Medicaid began soliciting providers for the mandatory re-enrollment in May of 2014. Overall provider response has been slow and the lack of significant progress toward meeting the December 31, 2015 deadline is concerning. As of October 26, 2015, only 68 percent (8,886 of its 13,008) of active providers have completed the re-enrollment process. While program staff realizes that not all out-of-state providers may opt to continue participation with Wyoming Medicaid, a significant number of Wyoming based medical, institutional and waiver providers remain in that remaining 32 percent.
In an attempt to urge providers who have waited until the eleventh hour to begin the process, Wyoming Medicaid has launched additional targeted outreach efforts. Individual provider letters were mailed out this week to all 4,122 providers who have yet to re-enroll. These letters contain each provider’s NPI, Medicaid ID number, enrolled taxonomy and detailed instructions on completing the re-enrollment process. The enrollment process may take 8-10 weeks, Wyoming Medicaid strongly encourages all providers to verify enrollment status and begin re-enrollment as applicable. As of December 31, 2015, Wyoming Medicaid will be required to deactivate providers who have not re-enrolled.
While future provider enrollment applications will continue to be accepted and processed, payment for services rendered cannot be made until provider enrollments are complete. To avoid payment interruption, Wyoming Medicaid encourages all providers who have not re-enrolled since May of 2014 to begin immediately.
Finally, Wyoming Medicaid would like to bring attention to the final major provider initiative. A second component of the ACA provider screening and enrollment requirements is the mandatory enrollment of all ordering, referring and prescribing providers. This means that every provider in your practice or group with prescribing or ordering rights (for prescriptions, radiology, laboratory services, durable medical equipment, therapies, etc.) must be an enrolled Medicaid provider (physician assistants, nurse practitioners, etc.).
All direct service providers billing for these ordered tests (radiology, pharmacies, therapists, durable medical equipment providers) will then be required to submit claims documenting the referring, ordering and/or prescribing provider. Without this field populated with the unique NPI of a Medicaid-enrolled ordering, referring and/or prescribing provider, claims will deny for payment. Wyoming Medicaid has never mandated enrollment of these non-billing providers historically, but now has been mandated to require enrollment by the Centers for Medicare and Medicaid Services and will be moving forward.
Additional communication from Wyoming Medicaid is forthcoming. Wyoming Medicaid asks all providers to review upcoming email bulletins and printed outreach materials carefully for further details and deadlines. Information is currently available on the Medicaid Provider Website, http://wyequalitycare.acs-inc.com/aca_reenrollment.html.