048-1 Wyo. Code R. § 1-6
(a) MCH programs are the payor of last resort following all other third party payors.
(b) Payments are made directly to approved providers for covered services. No payments will be made to families.
(c) Payment to approved providers is based on Wyoming EqualityCare rates with any applicable modifiers.
(d) Total annual payment for services for any MCH Program eligible client will be capped.
(e) All services must be approved for payment.
(f) Payment is made through the MCH fiscal agent(s).
(g) Services provided prior to the MCH eligibility date will not be paid.
(h) No payment will be made unless required billing is received by MCHs fiscal agent(s) within one (1) year from date of service.
(i) Any recovery of money by the family through legal actions, third party payors or other liabilities, shall be paid to the state to the extent that the state has incurred expenses.
(j) Excess payments may be recovered.
(k) Denial of non-covered services. The denial of services because they are not covered services is not an adverse action and the insured shall not be entitled to a reconsideration or administrative hearing.
048-1 Wyo. Code R. § 1-6