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Manuals

Wyoming Provider Manual

Wyoming DME Manual

Wyoming PASRR Manual

Criteria

Blue Ribbon Program

Acute Inpatient Psychiatric Hospitalization Criteria

Hypoglossal Nerve Stimulation Criteria

Psychiatric Residential Treatment Facilities Criteria Updated

Weight Loss Surgery Criteria

Initial Small Bowel Transplantation Criteria

Multivisceral Transplantation Criteria

SNF ECC Criteria Final

Waiver Skilled Nursing PA Criteria

WY Medicaid Policy for Transplant Services

WY Medicaid Policy for Vagus Nerve Stimulation for Epilepsy

Archive

Transition Announcement #2

Transition Announcement

Introduction to Telligen (Video)

Telligen Introduction and AO Training

PA and CSR Forms

Medical Surgical PA Request Form

Retrospective Review Admission Authorization

Transplant Prior Authorization Form

Genetic Testing Prior Authorization Form

PRTF Continued Stay Form

PRTF Prior Authorization Form

Skilled Nursing Extraordinary Care CSR Form

Skilled Nursing Extraordinary Care Admission Authorization Form

Dental Attestation Form

Dental Prior Auth Form

Malocclusion Request Form

Oral Surgery Request Form

SMP Under 12 Referral Form

Tooth Replacement Request Form

PASRR II Psych Evaluation Form

PASRR Informed Consent Form

Patient Weighted Quality of Life in Epilepsy Form

Provider Bulletins

DME PA and Policy Reminders and Updates 

Changes for CMS-1500 Professional 837P Claim Type Part 2 

Prior Authorization request changes for services billed using the CMS-1500 Professional 837P claim type

Behavioral Health Provider Bulletin 2/2022

Checklists

PASRR Evaluation Referral Packet Check List