Section 8-3 - Filing of Claims (a) Designated hospitals or treatment providers filing claims with the Department or responsible county under Wyo. Stat. Ann. § 25-10-112 for services provided pursuant to Wyo. Stat. Ann. § 25-10-109, Wyo. Stat. Ann. § 25-10-110 or Wyo. Stat. Ann. § 25-10-110.1 shall provide documentation to the Department or responsible county detailing the services rendered and the payment requested. This documentation shall include, but is not limited to: - (i) All relevant and requested medical records directly related to the services for which payment is being requested;
- (ii) An itemized billing statement (for services provided by designated hospitals) for services, including:
- (1) A universal billing form;
- (iii) The emergency detention notice, Form 3-81, and the continued emergency detention court order, if applicable;
- (iv) The involuntary hospitalization court order, if applicable, and any papers showing the patient's release from involuntary hospitalization, Form 14-81.
- (v) A certification signed by the designated hospital representative or treatment provider, indicating that the patient has no public or private health insurance and that there are no other governmental benefit programs from which it can recover the costs of treatment;
- (vi) Documentation of all efforts made to recover costs of treatment from public and private health insurance, and from government benefit programs prior to seeking payment from the Department.
(b) The Department may not pay claims submitted more than one (1) year after the service date.
(c) The Department may not pay claims for medical treatment for conditions that are not directly related to the emergency detention or involuntary hospitalization.