048-3 Wyo. Code R. § 3-7

Current through April 27, 2019
Section 3-7 - Provider Records

(a) Retention. A provider shall maintain medical and financial records, including information regarding dates of services, diagnoses, services furnished, and claims, for at least six years after the end of the state fiscal year in which payment for services was rendered. If any litigation, claim, audit or other action involving the records is initiated before the expiration of the six years, the records must be maintained until the litigation, claim, audit or other action and any subsequent administrative or legal proceedings are resolved. Such records must be maintained for three years in hard-copy, after which they may be maintained on micro-fiche or micro-film.

(b) Documentation requirements. A provider must have completed all required documentation, including required signatures, before or at the time the provider submits a claim to the Division. Documentation prepared or completed after the submission of a claim will be deemed to be insufficient to substantiate the claim and Medicaid funds shall be withheld or recovered.

(c) Availability of records. A provider shall make financial or medical records available upon request to representatives of the Division, the United States Department of Health and Human Services, HCFA, the Comptroller General of the United States, the Wyoming Attorney General or the MFCU . Such visits may be made pursuant to Chapter 16, and may be announced or unannounced.

(d) Refusal to produce or maintain records. The refusal of a provider to make financial or medical records available and accessible shall result in:

  • (i) The immediate suspension of all Medicaid payments to the provider;
  • (ii) All Medicaid payments made to the provider during the record retention period for which records supporting such payments are not produced shall be repaid to the Division within ten days after written request for such repayment; and
  • (iii) The suspension of all Medicaid payments for services furnished after such date.
  • (iv) Reimbursement shall not be reinstated until the Division determines that adequate records have been produced or are being maintained.

(e) Copying records. The Division may copy records pursuant to the record copying provisions of Chapter 16, which are incorporated by this reference.

048-3 Wyo. Code R. § 3-7