Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 8 - INPATIENT HOSPITAL ADMISSION CERTIFICATION
Section 8-9 - Hospital Responsibilities
Universal Citation: WY Code of Rules 8-9
Current through September 21, 2024
A hospital which seeks Medicaid payment for inpatient hospital service provided to a client shall:
(a) Obtain an admission certification pursuant to this Chapter, if required.
(b) Request a written admission form to provide certification by contacting the Department in writing as required by the Department and provide the following information:
(i) The attending physicians name and
National Provider Identifier (NPI) number;
(ii) The clients name, Medicaid
identification number and date of birth;
(iii) The name of the hospital;
(iv) The principal diagnosis by narrative
description or diagnostic code according to the International Classification of
Disease (ICD), as specified by the Department;
(v) The primary procedure by narrative
description or procedure code according to the Current Procedural Terminology
(CPT), as specified by the Department;
(vi) Whether the admission is a
readmission;
(vii) The expected
date of admission; and
(viii)
Information from the plan of care and information concerning the reason for
admission as requested by the Department to determine if admission meets the
medical necessity criteria.
(c) Provide the following information when applicable:
(i) Surgeons name and NPI
number;
(ii) Expected date of
surgery; and
(iii) Affirmation that
any required prior authorization has been received.
(d) Enter the admission certification and any required prior authorization number on all claims submitted to the Department.
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