Provider Eligibility

Provider Eligibility

Provider Eligibility

Eligibility Requirements.

The Wyoming Medicaid EHR Incentive Program for Eligible Professionals is based on individual practitioners. If a provider is part of a practice, each Eligible Professional may qualify for an incentive payment if they successfully adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in the first year of participation, and successfully demonstrate meaningful use for subsequent participation years. Each Eligible Professional is only eligible for one incentive payment per year, regardless of the number of practices or locations at which he or she provides services. To qualify for the Medicaid EHR Incentive, an Eligible Professional must have a minimum percentage of Medicaid patient volume (see below).

Hospital Based-Professionals with 90% of services performed in an inpatient hospital (Place of Service Code 21) or emergency room (Place of Service Code 23) setting are not eligible. Behavioral Health Professionals (such as psychologists and substance abuse counselors) are not eligible.

Certified Electronic Health Record (EHR) technology are products that have been tested and certified under the Office of the National Health Information Technology Coordinator (ONC) in accordance with the standards, implementation specifications, and certification criteria set forth in the ONC’s Final Rule.

CLICK HERE for a list of Certified EHR products.

CLICK HERE to learn more about Meaningful Use.

Eligible Professionals.

Providers that qualify as Eligible Professionals under WyMIPP include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse Practitioners
  • Certified Nurse-Midwives
  • Dentists
  • Physician Assistants who furnishes services in a Physician Assistant led Federally Qualified Health Center or Rural Health Clinic.

CLICK HERE for more information on Eligible Professionals.

Medicaid Patient Volume.

To qualify for an incentive payment under WyMIPP, an eligible professional must meet one of the following criteria:

A minimum 30% Medicaid patient volume.*

For Pediatricians, a minimum 20% Medicaid patient volume.*

Practice predominantly (more than 50% of encounters over a 6-month period) in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals.**

Professionals must meet patient volume threshold requirements for a continuous 90-day period in the preceding calendar year.

For assistance with Medicaid patient volume, contact Wyoming Medicaid at 1-307-777-7594.

Professionals have the option of using practice or clinic-level patient volume to meet the required threshold. CLICK HERE for CMS requirements for using patient or clinic level volume.

* Children’s Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.

** Section 1903 (t) (3) (F) of the Act defines needy individuals as individuals meeting any of the following three criteria: they are receiving medical assistance from Medicaid or the Children’s Health Insurance Program (CHIP); they are furnished uncompensated care by the provider; they are furnished services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

Medicare EHR Incentive Program.

Professionals may be eligible for both the Medicare and Medicaid EHR Incentive Programs. Providers must choose which incentive program they wish to participate in when they register, as participation in both programs is not allowed. Before 2015, an Eligible Professional may switch programs only once after the first incentive payment is initiated. Most Eligible Professionals will maximize their incentive payments by participating in the Medicaid EHR Incentive Program.

CLICK HERE for more information on the Medicare EHR Incentive Program.