Wyoming Administrative Code
Agency 053 - Workforce Services, Department of
Sub-Agency 0021 - Workers' Compensation Division
Chapter 9 - FEE SCHEDULES
Section 9-1 - General Guidelines

Universal Citation: WY Code of Rules 9-1

Current through September 21, 2024

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: https://dws.wyo.gov/dws-division/workers-compensation/resources-information/provider-bulletins.

(c) The Division shall use accepted medical resources and publications to aid in adjudicating bills. This shall include, but not be limited to, the most recent edition of the following sources at the time services are rendered; the American Medical Association (AMA), Optum 360, Current Procedural Terminology code book (CPT), the AMA Knowledge Base System and The American Academy of Orthopaedic Surgeons, Complete Global Values Service Data for Orthopaedic Surgery Guidelines, Centers for Medicare and Medicaid Services (CMS), 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 where no value is established in the Geographically Adjusted Resource Based Relative Value Scale (RBRVS) methodology will pay using gap fill values as established by OPTUM or By Report (BR); whichever is less. If the value is determined BR, a comparable code value will be assigned; if no value is found, the billed charges will be reduced by 20%.

(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.

(h) A health care provider or facility shall provide records to the Division without charge after a claim has been accepted.

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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