Wyoming Care Management Entity Instructions for Enrollment as a WY Medicaid Provider

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Gavin Lawrence
5 years ago
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Wyoming Care Management Entity Instructions for Enrollment as a WY Medicaid Provider To apply with Magellan as an approved Medicaid waiver provider: Please follow all instructions PRIOR to completing

Once you have completed full certification both Tier 1 and Tier 2 must be signed off on by a certified High Fidelity Wraparound (HFWA) coach or at minimum you have completed all of Tier 1 of HFWA

1 Wyoming Care Management Entity Instructions for Enrollment as a WY Medicaid Provider To apply with Magellan as an approved Medicaid waiver provider: Please follow all instructions PRIOR to completing the online Medicaid Provider enrollment with Xerox. Once you have completed full certification both Tier 1 and Tier 2 must be signed off on by a certified High Fidelity Wraparound (HFWA) coach or at minimum you have completed all of Tier 1 of HFWA Training you can: 1. Apply for a National Provider Identifier (NPI) number if YOU haven t already using the following website: Retain a copy of the acknowledgement letter you receive from NPPES. You will need this letter for your Medicaid application. 2. Complete an Interested Provider Form with Magellan to recieve a Medicaid Acknowledgement Letter. 3. Once you have all necessary documents, acknowledgementl letter from Magellan and acknowledgement letter from NPPES, you can proceed to Conduent Online Medicaid Provider Enrollment. Follow the Instructions for Online Enrollment Application process. Conduent Online Enrollment Application Submission Process 1. Print copies of the Magellan Approval Letter and the NPPES acknowledgement letter for your NPI number. 2. Go to the following website: 3. If you get a pop up message about the certificate, select continue to the website (even though it may say Not Recommended ), select it anyway to continue. 4. Enter the address you will want Conduent to use to communicate with you about your application. 5. You will get a reference number before you begin- PLEASE SAVE THIS NUMBER FOR LATER USE 6. You can save and recall your application at any time. To recall your application by returning to the website and entering your and reference number. 7. Follow instructions on the application and enter your information 8. For Type of Enrollment- Choose Individual Treating Practitioner 9. Complete the Provider Name section

10. Enter the physical address of the agency you work for 11. Answer No to is payment different from physical address 12. Answer No to different from correspondence 13.

2 10. Enter the physical address of the agency you work for 11. Answer No to is payment different from physical address 12. Answer No to different from correspondence 13. For Taxonomy Category Select Agencies 14. For Taxonomy Description Select the 251S00000X taxonomy code 15. Skip adding any other taxonomy codes 16. Enter you contact address 17. Select all notifications on the 18. You must click Add Contact Address after entering your contact address and be able to see in the line below before you save and continue to the next page 19. You may add as many addresses as you want notifications to be sent to 20. Enter your NPI information 21. Skip adding any other taxonomy codes

3 22. Answer no to owning 5% or more in any company that bills Medicaid 23. By answering No you Do Not need to complete the Ownership/Control Information 24. Answer the 5 questions below the Ownership/Control Information

4 25. Complete the Type of Business section 26. Complete the Tax Identifier Information (if you are part of an agency enter the agency TIN; if you are solo provider enter TIN or SSN if not incorporated as formal business) 27. Complete the Enrollment Period section 28. Leave the Enrollment End Date Blank 29. Answer the 5 questions 30. Skip DEA Number section 31. Answer no if you have never billed Medicaid before. Answer yes only if you have direct billed Medicaid for any other services linked to your NPI number. 32. Enter yes for are you a member of a group practice 33. Enter the Magellan API number listed on the approval letter and then select Add ID 34. Answer no to is your organization a subsidiary or joint venture

5 35. In the box for Additional Information, please add: MAGELLAN WY CME 36. Add your Contact Information for Enrollment 37. Please check the box to attest to the information you have entered is true, accurate, and complete 38. Save and Exit or Submit 39. Once you submit the application, you will be instructed to print the PDF with supplemental documentation. 40. PRINT the documents. 41. IN BLUE INK- clearly print all information on the Provider Enrollment Certification and sign that page, on page 3 of the certification, print your NPI number, print your name, sign and date, skip the EDI enrollment, and the WOLFS, on page 5 Print your name, address of your organization, and sign and date. 42. Gather your acknowledgement letter and submit together with all 3 pages of supplemental documents within 15 business days of submitting your online application to: WYOMING MEDICAID ENROLLMENT SERVICES PO BOX 667 CHEYENNE, WY

Group Provider Enrollment Tutorial. Revised 4/5/18

Group Provider Enrollment Tutorial Revised 4/5/18 1 Group Provider Enrollment Documents you will need: Copy of Confirmation Letter or email from the National Plan and Provider Enumeration System (NPPES)