Prescription drug coverage is just one of the services provided under the Medicaid umbrella, and is a mandatory service for child populations, but an optional service for adult categories of service. Pharmacy Services is committed to providing quality health care for Medicaid clients as well as all Wyoming citizens.
In addition to administering the multi-faceted Wyoming Medicaid Prescription Drug Program, Pharmacy Services oversees many other programs related to prescription drug services.
IMPORTANT CLAIMS INFORMATION
March 15, 2024
Dear Pharmacy Provider,
Please be advised that the Change Healthcare Provider Helpdesk personnel are available to assist pharmacies with Medicaid eligibility questions and other questions pharmacies may have. As of today, March 15, 2024, please contact them using their previous pharmacy helpdesk number at 1-877-209-1264.
We anticipate that claims will start processing per normal processes as of today, March 15, 2024, so please consider the following when attempting to submit claims that were dispensed during the outage:
• Make every attempt to submit claims from earliest date of service to most recent in order to avoid incorrect processing due to sequencing of submissions.
• No copays should be collected on any prescription dispensed during the outage, and will be turned off in the system when it becomes active.
• Prior authorizations will be removed, with the following condition codes being soft rejects which can be bypassed by resubmitting the claim:
o Reject Code 75 – PA Required
o Reject Code 76 – Plan Limitations Exceeded
o Reject Code 79 – Refill Too Soon.
• Please expect higher than average call volume to our Helpdesk, as well as potential congestion with switch vendors (i.e. RelayHealth) during resubmission.
• If you would like to set up an appointment to work directly with your pharmacy on submission of claims and troubleshooting, please call and let us know so that we can dedicate resources accordingly.
As this situation continues, we deeply appreciate your patience, understanding, and continued care of our Wyoming Medicaid clients.
March 6, 2024
Dear Pharmacy Provider,
We would like to genuinely thank you for your diligent efforts to serve Wyoming Medicaid clients during the ongoing Change Healthcare outage. In response to reports from clients and pharmacies regarding copay issues, Wyoming Medicaid is lifting prescription client copays for all clients for the duration of the outage.
A $0.00 copay will be programmed on claims process for dates of service within the dates of the outage (2/21/2024-end of the outage). Wyoming Medicaid will then pay the entire claim amount, including any copay amount usually collected from the client. Please be assured, we do not intend for pharmacies to lose reimbursement for the copay amount.
If your pharmacy has charged copays on prescriptions already filled since February 21, 2024, please consider voluntarily refunding those to Medicaid clients.
As a reminder, the Department will adjudicate and pay all clean claims submitted once the Change Healthcare system is operational; therefore, as stipulated by Section 5.H. of the Wyoming Medicaid Provider Agreement, providers should not bill, demand, or otherwise seek reimbursement from a Medicaid client (or representative of the client) for any service for which reimbursement is available from the Department in accordance with the Wyoming Medicaid Pharmacy Provider Manual.
The PDL and Provider Manual have been placed on the Wyoming Department of Health pharmacy page at https://health.wyo.gov/healthcarefin/medicaid/pharmacy-services/. Although PA requirements are being lifted, we urge you to examine the PDL to best navigate prior authorization criteria, especially with new prescriptions, to minimize the chance of a patient needing to switch to a preferred medication at their next fill.
For questions regarding a customer’s eligibility, you may utilize the Benefits Management System at 1-888-WYO-MCAD (1-888-996-6223), or call the Wyoming Medicaid office at 307-777-7531 to speak to someone in the pharmacy program.
Thank you for continuing to serve Medicaid clients and for your patience during this extremely challenging event.
Outage Response Information for Providers
The department will adjudicate and pay all clean claims submitted once the Change Healthcare system is operational; therefore, as stipulated by Section 5.H. of the Wyoming Medicaid Provider Agreement, providers should not bill, demand, or otherwise seek reimbursement from a Medicaid client (or representative of the client) for any service for which reimbursement is available from the department in accordance with the Wyoming Medicaid Pharmacy Provider Manual.
The PDL and Provider Manual have been placed on the Wyoming Department of Health pharmacy page at https://health.wyo.gov/healthcarefin/medicaid/pharmacy-services/. Although PA requirements are being lifted, we urge you to examine the PDL to best navigate prior authorization criteria, especially with new prescriptions, to minimize the chance of a patient needing to switch to a preferred medication at their next fill.
For questions regarding a customer’s eligibility, you may use the Benefits Management System at 1-888-WYO-MCAD (1-888-996-6223), or call the Wyoming Medicaid office at 307-777-7531 to speak to someone in the pharmacy program. For additional help, you may also call the normal pharmacy help desk number 1-877-209-1264, and you will be routed to an Optum Rx help desk.
New Provider Enrollment
Wyoming Medicaid would like to announce the transition of Medicaid provider enrollment and provider updates to our new vendor, HHS Technology Group. With this transition there will be a new provider portal specifically for providers to complete enrollments, re-enrollments, re-validations, make updates, and upload documents to their Medicaid provider file. Please click the link below to access the provider enrollment website.
FOR ANY QUESTIONS OR CONCERNS PLEASE EMAIL: WYProviderTraining@HHSTechGroup.com
List of Enrolled Pharmacies
Please refer to CHC for an updated list of currently enrolled pharmacies.
Change Healthcare (CHC)
Please refer to CHC for questions concerning the following:
- Prior Authorization (PA)
- Preferred Drug List (PDL)
- SMAC
- Pharmacy Policies
- Pharmacy Provider Manual
The Medication Donation Program
Legislation was passed by the Wyoming Legislature in 2005 allowing unused medications to be donated to participating donation sites for distribution to Wyoming residents who cannot afford to buy their needed medications.
Wyoming Medicaid Help
If you need to ask a question or file a concern about Medicaid services or providers, please click here.