Inpatient Census Reporting - Wyoming Department of Health

Wyoming Medicaid

Wyoming Medicaid is a joint federal and state government program that pays for medical care for some low-income and medically needy individuals and families.

Contact Info:

122 W 25th St., 4th Floor West
Cheyenne, WY 82001
(307) 777-7531
Fax: (307) 777-6964

Inpatient Census Reporting Requirements

All hospitals enrolled as Wyoming Medicaid providers are required to submit a weekly Inpatient Census Report. This includes out-of-state hospitals when they have Wyoming Medicaid members as patients in their facility.

Options to fulfill this requirement include:

1. Entering your data into the designated Google Form here: https://forms.gle/HvsYZkA4Sn2YBohC8

2. Connecting your system to the Wyoming Frontier Information System (WYFI) to include ADT alerts. If ADTs are sent to the WYFI system, the manual entry using the Google form isn’t required. For more information about this option, please view their website: https://health.wyo.gov/healthcarefin/wyoming_frontier_information_wyfi/

You can use the WYFI Connection Request Form to request someone contact you about setting up the connection.

For questions regarding the Inpatient Census Report process or requirements, please contact Amy.Buxton@wyo.gov.

Failure to Submit an ICR

Please note that failure to submit Inpatient Census Reports can result in recovery of part or all of the payment for a given hospital claim for any unreported or late reported members. Please see the Wyoming Administrative Rules, Health, Department of, Wyoming Medicaid, Chapter 29, Section 3:

Section 3. Hospital Reporting Requirements.

(a) A hospital is not entitled to receive the full Medicaid allowable payment for covered services furnished to a client unless the hospital has reported the client to the Department on an Inpatient Census Report (“ICR”), subject to the following provisions:

(i) A hospital shall submit an ICR to the Department by 5:00 p.m. on Friday of each week.

(ii) An ICR must:

(A) Be submitted electronically in the form and manner established by the Department; and

(B) Report each client admitted to the hospital since the last ICR deadline.

(iii) If a hospital fails to timely report a client on an ICR, the hospital may not report the client on a subsequent ICR unless the client has not yet been discharged from the hospital.

(iv) If a hospital makes a late report of a client on an ICR, the Department may reduce, by up to twenty-five percent (25%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.

(v) If a hospital altogether fails to report a client on an ICR, the Department may reduce, by up to one hundred percent (100%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.

(vi) If a hospital makes a late report of a client on an ICR late or altogether fails to report a client on an ICR and, nonetheless, the Department pays the hospital the full Medicaid allowable payment, the Department may recoup the overpayment pursuant to the procedures under Chapter 3 of Rules, Wyoming Department of Health, Medicaid (“the Medicaid Rules”).

(b) If a client is determined eligible for Medicaid only after discharge from the hospital, then the Medicaid allowable payment to the hospital shall not be reduced for failure to include that client on prior ICRs.