048-16 Wyo. Code R. § 16-11

Current through April 27, 2019

Section 16-11 - Educational Intervention

(a) If the Department determines that a provider's claims are not being submitted properly or a client has engaged in abuse of services, fraud, or theft, the Department may educate the provider or client or require the provider or client to participate in and complete an educational program. The Department will send a notice to the provider or client, which shall state the reason(s) for the educational intervention. The notice may also include:

• (i) The education available;

• (ii) The time and date of such education, if applicable; and

• (iii) That continued participation as a provider or client in Medicaid is contingent upon completion of the specified education by a date indicated in the notice.

(b) An educational program may be presented by the Department and shall provide instruction in the correct submission of claims, the appropriate utilization of services, or other such problems as are identified by the Department. A provider or client that is asked to participate in an educational program and refuses shall be suspended from participation in Medicaid until such time as the provider or client completes the required program.

048-16 Wyo. Code R. § 16-11