Optum is partnered with the Division of Healthcare Financing to provide health management services to Medicaid clients. The program aims to positively impact clinical outcomes while reducing healthcare costs by improving care coordination and reducing unnecessary exacerbation of acute and chronic illnesses. Services provided by Optum include:
- Utilization Management (UM) services for select medical procedures and admissions and full behavioral health admissions including Psychiatric Residential Treatment Facility (PRTF)
- Health Management services including case management and care coordination.
- A 24/7 nurse line
- Healthy Habits weight management program
- Appropriate ER Care Guidance program – focusing on Emergency Room usage
- Health and Wellness program
This program is patient-centric and provides education, support and resources to help each person understand their health and healthcare needs. Telephonic and filed based Health Coaches work with clients to encourage them to be active participants in their health.
Optum understands the importance of provider and patient relationships. Optum encourages and promotes patients to have a primary healthcare provider or medical home. Optum staff may assist providers with additional support and education with patients outside of the provider office. In addition, case management/care coordination services are available for more complex Medicaid clients. It is easy to make a referral to the program. You may call 1-888-545-1710 or fax a Care Management Referral Form to 1-888-245-1928.
The Optum provider manual provides program descriptions and contains the Utilization Management forms, Inpatient Census Reporting (ICR) instructions, Case Management referral form, and additional instructions, processes, and services. The manual can be accessed here. If you prefer to have a hard copy of the manual mailed to you directly, please call 1-888-545-1710 and request for a Provider Manual to be mailed to you at no cost.
Steps to Enroll
Steps to enroll:
In Wyoming, the Medicaid Program is administered by the Wyoming Department of Health, Division of Healthcare Financing, Office of Medicaid. We are pleased to report that the majority of Wyoming physicians participate in Medicaid and we encourage you to enroll. The Department contracts with Xerox, Inc. to operate our claims processing and reporting system.
1. Contact Xerox Provider Relations at 1-800-251-1268 to request an enrollment form and provider agreement or you may download the forms from the ACS website at https://wyequalitycare.acs-inc.com/wy/general/providerEnrollmentHome.do
2. Xerox will assign a provider billing number and will supply required billing information. Fee schedules are published on the website.
3. Xerox will arrange a provider visit with your office staff upon request to review billing requirements.
Electronic billing is available and questions regarding enrollment of claims processing should be directed to Xerox. Questions regarding Medicaid or reimbursement which are not directly related to claims processing should be directed to the Division of Healthcare Financing, Office of Medicaid at 307-777-7531.
If you have questions regarding your billing or enrollment, contact Xerox Provider Relations at 1-800-251-1268 or check out our click the frequently asked question toggle below.
Wyoming Medicaid Provider Manuals are also found on the Wyoming Medicaid website.
Frequently Asked Qustions by Providers
Frequently Asked Qustions by Providers
Q: How do I get a code covered by Medicaid?
A: A provider may contact Xerox, Inc. in writing with a request to cover any code not covered. This request must include a complete description of the item or services, the code or codes you wish to have covered, and the appropriate modifiers. You may mail this to Xerox, Inc., Provider Relations Unit, P.O. Box 667, Cheyenne, WY 82003-0667.
Q: How do I know what codes to use when billing for a service, equipment, or supplies?
A: The American Medical Association publishes two coding manuals each year. They are the Current Procedural Terminology CPT, and the Healthcare Common Procedure Coding System “HCPCS (pronounced hick picks).” Use these manuals to help you identify the correct codes for billing your services. Xerox, Inc. and the Division of Healthcare Financing, Office of Medicaid cannot advise you on which codes to use.
Q: How do I find out if Medicaid covers a procedure?
A: There are two methods you can use to find this information. First, click on Fee Schedule (on the Xerox web site). The fee schedule lists all the codes for medical procedures, equipment and supplies covered by Medicaid. Each code is assigned a fee and effective date. If your code is not listed, it may not be covered by Medicaid. The second method is to call Provider Relations at 1-800-251-1268 and ask if your specific code is covered.