Wyoming Application Service Provider Agreement

State:
Multi-State
Control #:
US-CP1027-AM
Format:
Word; 
Rich Text
Instant download

Description

This sample form, a detailed Application Service Provider Agreement document, is for use in the computer, internet and/or software industries. Adapt to fit your circumstances. Available in Word format.
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FAQ

Steps to enroll: Complete all the application steps including filling out the application, signing the Provider Agreement, confirming your information by signing the final application document, and mailing any financial information including the W-9 form, if you expect to receive payment from Medicaid.

Wyoming Medicaid is a joint Federal/state program established to pay for medical services for people with disabilities, people 65 years and older, children and their caretakers, and pregnant women who meet the program's financial requirements. Wyoming Medicaid | Benefits.gov benefits.gov ? benefit benefits.gov ? benefit

Part of Wyoming Medicaid, the Home and Community Based Services (HCBS) Section oversees waiver programs for individuals with developmental disabilities, acquired brain injuries, and who are ages 19-64 with a physical disability or ages 65+ who need nursing facility level of care.

Q: What is the timely filing limit for claims submissions/adjustments? A: Providers have 12 months from the date of service for claims submissions or within 6 months from the payment date on the Medicare Explanation of Medical Benefits (EOMB), or 90 days from the Third Party Liability (TPL) payment date. Provider FAQs | Serving Wyoming Medicaid Providers and Members wyomingmedicaid.com ? portal ? ProviderF... wyomingmedicaid.com ? portal ? ProviderF...

Wyoming offers three HCBS waivers: Community Choices Waiver (CCW) ? serves individuals aged 65 and older, or individuals aged 19 ? 64 who have a disability that is verified as meeting Social Security Administration (SSA) disability determination criteria.

Payer Name: Medicaid - Wyoming|Payer ID: 77046|Professional (CMS 1500) Medicaid - Wyoming|Payer ID: 77046|Professional (CMS 1500) thepracticebridge.com ? payerid-finder thepracticebridge.com ? payerid-finder

Effective November 1, 2022, all original claims submitted to Wyoming Medicaid must be filed electronically. CNSI, the Fiscal Agent, will no longer accept paper claims for any Medicaid service.

WYhealth Health Management is a benefit you have through Wyoming Medicaid. The program focuses on wellness for the Wyoming Medicaid population as well as those with complex medical conditions. Wyoming Medicaid Health Management (WYhealth) wyo.gov ? healthcarefin ? wyoming-medic... wyo.gov ? healthcarefin ? wyoming-medic...

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Wyoming Application Service Provider Agreement