Credentialing in Wyoming

"The Wyoming Department of Health is the single State agency… The Division of Healthcare Financing (DHCF) directly administers the Medicaid Program." The current CMS-1500 Provider Manual is v19.0, effective 2026-07-01, prepared by fiscal agent Acentra Health, and every individual practitioner needs their own provider number: "All individuals providing services must have their own Provider number."

Wyoming Medicaid CMS-1500 Provider Manual v19.0 (Acentra Health) · checked Jul 2026

Wyoming has no Medicaid MCOs, statewide fee-for-service through Acentra. The one managed layer: Magellan Healthcare is the Care Management Entity (CME) for high-need youth (Family Care Coordination, Family/Youth Peer Support, Youth and Family Training & Support, Respite) plus the Children's Mental Health Waiver (CMHW). CME prior authorizations come from Magellan, CME/CMHW claims are handled outside the standard flow, and CME telehealth uses POS 02 per the Magellan provider agreement, no GT/95 modifier, no Q3014.

Wyoming Medicaid CMS-1500 Provider Manual v19.0 (Acentra Health) · checked Jul 2026

W.S. 26-56-102 (applying to credentialing applications submitted on or after 2025-07-01) requires a receipt notice within 7 calendar days, an incompleteness notice within 30 calendar days, and that a health carrier "conclude the process of credentialing an applicant within sixty (60) calendar days" after the carrier receives the application. The clock pauses while the application is incomplete. There is no approval mandate.

Wyoming Statutes Title 26 (Insurance Code), official LSO compilation · checked Jul 2026

Pending, Section 2 of 2025 HB0082 (Enrolled Act No. 12), the bill that created W.S. 26-56-101 and 26-56-102, orders the Wyoming Department of Insurance to adopt rules for a uniform credentialing application. Watch for the DOI rule: it will standardize Wyoming commercial credentialing applications.

2025 Wyoming HB0082, Enrolled Act No. 12 · checked Jul 2026

Provisional Licensed Mental Health Professionals, Provisional Professional Counselors (PPC), Provisional Licensed Addictions Therapists (PLAT), Master of Social Work with Provisional License (PCSW), and Provisional Marriage and Family Therapists (PMFT), "may enroll with a CMHC or SATC, physician, psychologist, or under the supervision of an LMHP," and bill with the "group's NPI as the pay to Provider, and their individual treating Provider NPI as the rendering Provider at the line level." There is no solo lane: "Provisionally licensed mental health professionals cannot bill Medicaid directly," and they may only render under the clinical supervision of a DQCS (Designated Qualified Clinical Supervisor).

Wyoming Medicaid CMS-1500 Provider Manual v19.0 (Acentra Health) · checked Jul 2026

Wyoming is a Counseling Compact member (on the counselingcompact.gov jurisdictions list) but was not yet issuing as of July 2026; live states as of 2026-07-04 were AZ, GA, IN, LA, MN, and OH.

Counseling Compact, Compact Jurisdictions · checked Jul 2026

The Wyoming Medicaid provider portal is evoBrix (SSO from wyomingmedicaid.com); new-provider enrollment runs through the "HHS Provider Enrollment" site at wyoming.dyp.cloud ("Become A Provider").

wyomingmedicaid.com provider portal · checked Jul 2026

Taxonomies 101YP2500X (LPC) and 106H00000X (licensed AND provisional MFT) are Medicare-enrollable "Effective with dates of service 01/01/2024" and "are required to bill Medicare prior to billing Medicaid" for dual-eligible members. An LPC/LMFT group serving duals must complete Medicare enrollment or those members become unbillable.

Wyoming Medicaid CMS-1500 Provider Manual v19.0 (Acentra Health) · checked Jul 2026

Providers who sponsor residents and student interns bill utilizing the clinical supervisor's NPI and the HL (Intern) modifier, a supervisor-renders lane distinct from the provisional-licensee own-NPI lane.

Wyoming Medicaid CMS-1500 Provider Manual v19.0 (Acentra Health) · checked Jul 2026

If an applicant becomes credentialed "and a fully executed contract between the health care provider and the health carrier is in effect prior to covered services being provided," the carrier shall "reimburse the applicant for all covered reimbursable health care services… beginning with the date the health carrier received a completed credentialing application." Contract-execution timing is a separate gate from credentialing approval. A slow contracting step can strand the retro window, so date-stamp the completed application and push contract execution the moment approval lands.

Wyoming Statutes Title 26 (Insurance Code), official LSO compilation · checked Jul 2026