WYhealth...Get Plugged In!

The Care Management Program with Wyoming Medicaid

Provider Manual 

Information included in the Provider Manual:

1 WYHealth… Get Plugged In!

Health and Wellness

WYHealth…Get Plugged In Website

Healthy Habits Weight Management Program

Case Management

Behavioral Health Case Management

Wrap Around Model

Appropriate Care Site Program (Emergency Room)

Pharmacy Lock in Program

Wyoming Department of Health Oral Health Programs

Preventive Pediatric Care

Severe Crippling Malocclusion Program

Contact numbers for Oral Health programs:

WY Medicaid Waiver Programs

Breast and Cervical Cancer

Pay for Participation (P4P)

Disability Determinations

Pre-Admission Screening and Resident Review (PASRR)

Total Health Record

THR for Medicaid Providers

THR for Patients

Transportation

Xerox Networking Activities

Providers

Patients

Community

Satisfaction Surveys

Grievance and Complaint Process

2 Utilization Management

Prior Authorization

Submission of Information for the Prior Authorization

Criteria for Review

Approval of Prior Authorization (PA)

Denial of Prior Authorization

Appeal Process

Failure to Obtain a Timely Prior Authorization

Acute Admissions

Continued Stay Reviews

Case Management Services

Failure to Obtain Timely Admission Authorization

Retroactive Eligibility

Admission Authorization Notification

Continued Stay Reviews

Submitting a CSR

CSR Determination

Extraordinary Care

Retrospective Reviews

Procedure for Obtaining a Retrospective Review

Utilization Timeline Requirements

Random Post Pay Reviews

Focused Reviews

Mortality Reviews

3 Psychiatric Residential Treatment Facility

Definition

Prior Authorization for PRTF

PRTF Length of Stay

PRTF Admission Criteria

Continued Stay Reviews for PRTF

4 Inpatient Census Report (ICR)

ICR Requirements

5 Utilization Management Forms

6 Referral Forms

7 Utilization Management Criteria

Wyoming Nursing Facility Extraordinary Care Criteria

 

Click here for the Wyoming Provider Manual 






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