048-8 Wyo. Code R. § 8-4

Current through April 27, 2019

Section 8-4 - Payment of Claims

(a) Payment made by the Department pursuant to Wyo. Stat. Ann. § 25-10-112, for services provided by a designated hospital or other treatment provider under Wyo. Stat. Ann. § 25-10-109 and Wyo. Stat. Ann. § 25-10-110, shall not exceed:

• (i) The current rate for similar services as determined by Medicaid;

• (ii) A fixed, all-inclusive per diem rate as determined by the Department; or

• (iii) Payments arranged through mental health or substance abuse contracts with the Behavioral Health Division, if applicable.

(b) In considering a claim for payment, the Department shall determine if the costs submitted by the designated hospital or treatment provider are reasonably related to the care furnished to the patient and if the care furnished to the patient was medically necessary for the specific treatment of the patient's mental illness.

(c) After a designated hospital has submitted all documentation as required in Section 4(b) of Chapter 7, the Department shall pay each claim within 45 days of receipt of the claim pursuant to Wyo. Stat. Ann. § 16-6-602.

048-8 Wyo. Code R. § 8-4

Amended, Eff. 4/4/2017.