Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES
Section 2-25 - Medical necessity reviews
Universal Citation: WY Code of Rules 2-25
Current through September 21, 2024
(a) WDH may review medical records or conduct on-site medical necessity reviews to determine whether the services a recipient is receiving are medically necessary.
(b) Unnecessary services. If a medical necessity review discloses that a provider has been furnishing services that are not medically necessary and has received Medicaid payments for those services, the Department shall recover the excess payments pursuant to Section 26.
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