048-16 Wyo. Code R. § 16-3
(a) Payment for Colonoscopies Performed Prior to Enrollment Approval. There will be no reimbursement to providers for colonoscopies performed prior to the date the applicant obtains WCCEDP approval. The applicant/patient assumes all responsibility for any costs relating to procedures performed prior to the Enrollment Start Date.
(b) Enrollment Period. A client who is enrolled in the WCCEDP will remain in the program until they are eligible for Medicare at age 65, or until proper insurance coverage and financial resources become available to the client. If a client does not obtain a screen within three (3) months of initial enrollment approval, he/she will be notified in writing that enrollment approval may be terminated if screening is not obtained within the next ninety (90) calendar days. If provider capacity is insufficient at the time of enrollment approval, an extension may be given at the Department's sole discretion.
(c) Decision-Making Process. Upon receipt of an application, it will be reviewed and approved or denied by a minimum of two WCCEDP team members. If a decision is complex and cannot be determined by the team members, the case may be referred to the Program Manager for an enrollment decision. If a decision still cannot be made, the State Health Officer may assist in making enrollment decisions.
(d) Notification to Applicants of Approval or Denial. Eligibility is not determined online or over the telephone. Applicants are informed in writing whether their application has been approved or denied. Reasons for denial will be specified in the letter.
(e) Review Process. Applicants who are denied enrollment approval may submit a written letter explaining their situation or they may request that their healthcare provider submit a written explanation. These letters shall be submitted to the Program Manager for review. A review team, including the program nurse, is formed within the Department to respond to the applicant's letter. The Department will make every effort to respond to the applicant's letter within ten (10) work days.
(f) Cancer Treatment. The WCCEDP does not cover costs of treatment relating to a cancer diagnosis. In the event the patient does not qualify for Medicaid, the Nurse Manager acts as a patient navigator to aid the individual in locating or identifying resources to help reduce the burden of a cancer diagnosis on the enrolled program participant.
048-16 Wyo. Code R. § 16-3