048-36 Wyo. Code R. § 36-4

Current through April 27, 2019

Section 36-4 - Definitions

Except as otherwise specified in Chapter 1 or this Chapter, the terminology used is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

(a) "Ambulance." An ambulance as defined by Chapter 15.

(b) "Department of Transportation (DOT)." The Wyoming Department of Transportation, its agent, designee or successor.

(c) "Excess payments." Medicaid funds received by a provider, to which the provider is not entitled for any reason, including payments which exceed the Medicaid allowable payment. "Excess payments" includes, but is not limited to:

(i) Overpayments;

(ii) Payments made as a result of system errors;

(iii) Payments for services furnished to an individual that is not a client;

(iv) Payments for non-covered services furnished to a client;

(v) Payments for services which are not documented or supported by medical records or financial records;

(vi) Payments for services for which admission certification has been denied or withdrawn;

(vii) Payments which exceed a provider's usual and customary charge, unless otherwise permitted by the Department's rules.

(d) "Local trade area." The geographic area surrounding the client's residence, excluding portions of states other than Wyoming, that is commonly used by other persons in the same area to obtain similar services.

(e) "Medical appointment." A scheduled appointment with a provider.

(f) "Reimbursement request and certification." Documentation, in the form specified by the Department, that contains:

(i) An itemized statement of the administrative transportation for which a client is requesting reimbursement; and

(ii) The original signature of the client or other payee that receives the reimbursement.

(g) "Subsidized public transportation." Public transportation carriers that receive a subsidy from the Department of Transportation.

(h) "Wyoming Rural Transit Program." The transportation program operated by the Wyoming Department of Transportation.

048-36 Wyo. Code R. § 36-4

Amended, Eff. 6/14/2017.