053-9 Wyo. Code R. § 9-1
Pursuant to Wyoming Statutes § 27-14-401(b), (e), and (g) medical and or hospital care shall be reviewed for appropriateness and reasonableness and shall be reimbursed according to the adopted schedule(s). The following guidelines are applicable to each section within this chapter.
(a) All claims shall be paid in accordance with the fee schedule in effect at the time of service.
(b) Certain services may be subject to preauthorization pursuant to Chapter 10 of these rules. These guidelines can be found at: http://www.wyomingworkforce.org/providers/preauth/
(c) The Division shall use accepted medical resources and publications to aid in adjudicating bills. This shall include, but not be limited to, the American Medical Association (AMA) (2018), Current Procedural Terminology codebook (CPT) (2018), the AMA Knowledge Base System (2018), and The American Academy of Orthopaedic Surgeons (2018), Complete Global Values Service Data for Orthopaedic Surgery Guidelines (2018), and the Division's medical advisors.
(d) The Division may change billed codes to achieve compliance with the current rules and regulations. The provider payment statement shall advise of code changes and the right to appeal.
(e) Codes designated as Relativity Not Establish (RNE), or By Report (BR) shall be assigned the unit value of a comparable procedure or procedures.
(f) In no case shall any provider bill for charges greater than those charged the general public for like services.
(g) The Division shall not pay more than the total billed amount.
053-9 Wyo. Code R. § 9-1
Amended, Eff. 12/12/2017.
Amended, Eff. 5/23/2018.