2015 Wyoming Medicaid Medical and Institutional Workshops Presenters: Amy Buxton – Provider Services Manager Sheree Nall – Provider Services Manager Sara Rogers – Facilities Manager Brenda Stout – Behavioral Health Manager

Session Topics: Introductions Medicaid Decision Making WY Medicaid ICD-10 Project Upcoming Program Changes – Chiropractic – Mental Health Provisional Providers 2

Program Managers Amy Buxton – Ambulance, DME, Hearing and Audiology, Lab and Radiology, PT/OT/ST, Client Transportation Sheree Nall – Physician and Nurse Practitioner Services, Indian Health Services, ASC, Health Homes, Family Planning Waiver, Public Health Nurses Sara Rogers – Hospitals, ESRD, Nursing Home, RHC/FQHC, PRTF, CORF Brenda Stout – CMHC/SATC and Mental Health Services 3

Medicaid Decision Making Process Code of Federal Regulations (CFR) – Title 42 – Public Health – Wyoming State Statutes – Title 42 – Welfare – Wyoming Medical Assistance and Services Act – 4

Wyoming State Rules – Agency: Health, Department of – Program: Medicaid – Wyoming Medicaid State Plan – Approved by Centers for Medicare/Medicaid Services (CMS) – 5

Wyoming State Legislature – Statutes and Budget Governor - Statutes and Budget Wyoming Medicaid, Division of Healthcare Financing – State Medicaid Agent – Provider Operations Administrator – Program Manager 6

ICD-10 – Coding Specificity – All required digits must be present – Review ICD-10-CM book for required digits – Claims will deny if codes are not complete – Unspecified codes will not be accepted 7

Systems & Interface Testing Testing – Provider end-to-end testing is in progress – register at – Providers will be able to test specific clinical scenarios to evaluate coder competency and/or evaluate claim processing and denial rates for batches of test files submitted – MUST REGISTER TO TEST – all providers are encouraged to register for testing 8

Why Test? Avoid payment and cash flow interruption Ensure revenue neutrality – specifically hospital and inpatient level of care payments Ensure billing process readiness and system capability for interfacing and transmitting ICD-10 claims to Wyoming Medicaid: YOUR BILLING SYSTEM MAY NEED UPGRADES OR ADDITIONAL CONFIGURATION EVEN IF YOUR BILLING STAFF IS PREPARED! At the conclusion of testing, providers will be provided with a summary of testing action, denial/paid rates, edits that posted and payment variances detected. 9 WHY TEST?

Billing after 10/1/2015 will be date of service (DOS) driven: DOS prior to 10/1/2015 MUST be billed with an ICD-9 diagnosis/surgical procedure code. DOS 10/1/2015 and after MUST be billed with an ICD-10 diagnosis/surgical procedure code. Inpatient services that span September 2015 – October 2015 MUST have ICD-10 coding requirements, as the “through” DOS will determine coding requirements. 10

New Programs and Program Changes Chiropractic Mental Health Provisional Providers 11