Wyoming - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Wyoming Department of Health (WDH) Division of Healthcare Financing certifies Case Management providers to operate under the Community Choices Waiver (CCW), Comprehensive Waiver, and Supports Waiver. This service encompasses assessment, person-centered service planning, referral, and monitoring across the participant's full service package.

Approval requires strict adherence to conflict-of-interest regulations outlined in 048-45 Wyo. Code R. § 45-5, which prohibit case management agencies and their managing employees from owning, operating, or having a financial interest in any other entity providing direct services to a waiver participant. Applicants must also meet specific degree and experience thresholds and secure access to the Wyoming Health Provider (WHP) portal before an application is accepted.

1. Service Definition and Scope

In Wyoming, Case Management is defined under 048-34 Wyo. Code R. § 34-17 as assisting participants with accessing CCW, DD waiver, and Wyoming Medicaid State Plan services. The service ensures individuals receive comprehensive support tailored to their specific needs.

The scope includes identifying and coordinating access to necessary resources, monitoring service delivery, and maintaining the individualized plan of care.

• Participant Choice: Participants select a case management agency from a list of all qualified agencies serving their county of residence.
• Primary Assignment: The selected case management agency must assign one person to serve as the primary case manager based on the participant's preferences.
• Backup Requirement: Agencies must identify a backup case manager from the Division's certified list for each participant.
• Conflict Documentation: Providers must document on the individualized plan of care that they have no conflict of interest with the participant or family.

2. Regulatory and Oversight Agencies

The Wyoming Department of Health (WDH) is the primary state agency responsible for HCBS waiver programs. Within WDH, the Division of Healthcare Financing manages provider certification and Medicaid policy.

Medicaid provider enrollment and claims processing are managed through a portal operated by Magellan of Wyoming.

• Wyoming Department of Health (WDH): Oversees HCBS waiver programs and provider certification (https://health.wyo.gov).
• WDH Division of Healthcare Financing: Manages Medicaid policy, waiver administration, and the CCW/DD waivers (https://health.wyo.gov/healthcarefin/hcbs).
• Wyoming Health Provider (WHP) Portal: The system used for submitting HCBS provider certification applications (https://www.wyoproviderportal.com/).
• Wyoming Medicaid Provider Portal: Managed by Magellan of Wyoming for Medicaid enrollment and claims (https://wyoming.dyp.cloud/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Wyoming does not utilize a Certificate of Need or closed RFP process for HCBS case management. However, strict conflict-of-interest rules and educational thresholds act as structural preconditions that block ineligible applicants.

Prospective providers must also secure access to the state's proprietary portal before any application documents can be submitted.

• Conflict of Interest Prohibition: Agencies and managing employees cannot own, operate, be employed by, or have a financial interest in any other entity providing services to a participant (048-45 Wyo. Code R. § 45-5).
• WHP Portal Access: Applicants must request and be granted access to the Wyoming Health Provider (WHP) portal before an application can be initiated.
• Degree and Experience Thresholds: The applicant must hold at least an Associate's degree in a related human services field with four years of experience, or a higher degree with less experience.
• NPI Requirement: Case managers must obtain a National Provider Identifier (NPI) in their own name prior to Medicaid enrollment.

4. Licensure and Certification Requirements

Wyoming does not issue a traditional facility license for HCBS case management. Instead, providers undergo HCBS Provider Certification through the WDH Division of Healthcare Financing.

The certification process is entirely digital and requires strict adherence to state-mandated formatting and timelines.

• Certification Authority: WDH Division of Healthcare Financing certifies providers under 048-45 Wyo. Code R. § 45-5.
• Application Window: Applications initiated in the WHP portal must be submitted within 90 days or they are automatically canceled.
• File Naming Convention: Applicants must rename all uploaded files according to the CCW WHP File Naming Conventions guidelines.
• Age Requirement: All individual waiver providers and staff must be at least 18 years old.

5. Medicaid Provider Enrollment

After receiving HCBS certification, providers must enroll in Wyoming Medicaid to bill for services. This process is handled through the state's MMIS portal.

Enrollment requires selecting the correct provider type and signing a binding agreement with the state.

• Enrollment Portal: Applications are submitted through the Wyoming Medicaid Provider Portal (https://wyoming.dyp.cloud/).
• Provider Type: Applicants must select the correct PRESM Provider Type during the enrollment process.
• Provider Agreement: Providers must sign the Wyoming Medicaid Provider Agreement upon enrollment.
• Renewal Cycle: Medicaid enrollment and the Provider Agreement must be renewed every 5 years.

6. Staffing, Training and Background Checks

Case managers in Wyoming must meet specific educational criteria outlined in 048-45 Wyo. Code R. § 45-5 and complete state-mandated training modules.

Background screenings must be completed prior to submitting the certification application.

• Master's Degree Pathway: Master's in Counseling, Education, Gerontology, Human Services, Nursing, Psychology, Rehabilitation, Social Work, or Sociology.
• Bachelor's Degree Pathway: Bachelor's in a related field plus one (1) year of work experience in human or social services.
• Associate's Degree Pathway: Associate's in a related field plus four (4) years of work experience in human or social services.
• CPR/First Aid: Must maintain current certification including hands-on training from AHA or Red Cross.
• Initial Training: Must complete Initial Provider Trainings and specific Case Manager Training Modules prior to application.
• Continuing Education: Case managers must obtain and provide evidence of eight (8) hours of continued education annually.
• Background Screenings: Must successfully pass a multi-step background screening process before application submittal.

7. Documentation, Policies and Records

Agencies must maintain specific operational policies, particularly regarding backup coverage and conflict of interest.

Documentation must be readily available for Division review and uploaded to the designated portal.

• Backup Case Management Policy: Procedures for how and when the backup case manager notifies the plan of care team.
• Quarterly Review Notes: Documentation in case notes proving the primary case manager met with the backup quarterly to review all participant cases.
• Training Summaries: Summaries of completed Case Manager Training Modules must be available for Division review.
• Technology Requirements: Providers must maintain a valid email address, internet access, and the means to upload documentation into a Division designated portal.

8. Billing, Rates and Claims

Billing for case management services is processed through the Wyoming Medicaid MMIS. Rates are established by the WDH Division of Healthcare Financing.

Providers must ensure any third-party billing entities are properly enrolled with the state.

• Claims System: Claims are submitted via the Wyoming Medicaid Provider Portal (https://wyoming.dyp.cloud/).
• Billing Agent/Clearinghouse: Providers using a Billing Agent or Clearinghouse must ensure the BA/CH completes the Wyoming Medicaid enrollment process.
• Rate Setting: Fee schedules and procedure codes are published by the WDH Division of Healthcare Financing and updated periodically.
• NPI Billing: Claims must be submitted using the individual case manager's NPI number obtained during enrollment.

9. Approval Sequence and Timeline

The approval process in Wyoming follows a strict sequence, beginning with portal access and ending with Medicaid enrollment.

Applicants must complete training and background checks before formally submitting their application.

• Step 1: Request WHP portal access (allow up to 48 hours for approval).
• Step 2: Complete required Initial Provider Trainings and multi-step background screenings.
• Step 3: Submit the HCBS certification application via the WHP portal within 90 days of initiation.
• Step 4: Receive HCBS certification from the WDH Division of Healthcare Financing.
• Step 5: Complete Wyoming Medicaid Enrollment and sign the Provider Agreement.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors or failure to meet strict conflict-of-interest standards.

Attention to detail regarding file naming and training documentation is critical for approval.

• Application Expiration: Applications are automatically canceled if not submitted within the 90-day window in the WHP portal.
• File Naming Errors: Failure to strictly follow the CCW WHP File Naming Conventions before uploading documents.
• Conflict of Interest Violations: Operating or having a financial interest in another direct service provider entity.
• Invalid CPR Training: Submitting CPR/First Aid certifications that lack the required hands-on training component.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact the credentialing division for specific application questions.

Medicaid enrollment questions are handled by a separate customer service center.

• WDH HCBS Credentialing: [email protected] (https://health.wyo.gov/healthcarefin/hcbs/contacts-and-important-links/)
• Provider Enrollment Customer Service: 1-877-399-0121 (https://health.wyo.gov/healthcarefin/medicaid/for-healthcare-providers)
• Wyoming Health Provider (WHP) Portal: https://www.wyoproviderportal.com/
• Wyoming Medicaid Provider Portal: https://wyoming.dyp.cloud/

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