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- info@stream-rcm.com
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Stream RCM provides medical billing services in Wyoming for hospitals, critical access hospitals, physician practices, rural health clinics and specialty groups in Cheyenne, Casper, Laramie, Gillette, Rock Springs, Sheridan, Riverton and other Wyoming communities. Our medical billing team handles Wyoming Medicaid and Kid Care CHIP claims through Acentra Health, Medicare claims through Noridian Healthcare Solutions and commercial claims with insurers such as Blue Cross Blue Shield of Wyoming and Cigna. We check every claim against each payer’s rules before submission.
Wyoming Medicaid claims can be denied because of missing insurance details, used up visit limits or expired provider enrollment. The Wyoming Department of Health (WDH) pays providers directly on a fee-for-service basis, with no Medicaid managed care plans involved. In state fiscal year (SFY) 2025, 3,519 providers received Medicaid payments, and WDH estimated $24.8 million in third-party liability (TPL) cost avoidance, according to the WDH SFY 2025 annual report.
Paid Medicaid Providers
Unique Medicaid Enrollees
2024 Medicaid Births
Wyoming Medicaid sets different visit limits for adults and children. Adults 21 and older get 12 office visits a year before extra review, plus 20 physical therapy, 20 occupational therapy and 30 speech therapy visits. More visits can be approved when medically necessary. Children get care through Health Check, Wyoming’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, without the adult limits. Kid Care CHIP has been part of Wyoming Medicaid since October 1, 2020. Magellan Healthcare manages youth wraparound care through the Care Management Entity (CME) program.
Stream RCM medical billing specialists support family practices, rural health clinics (RHCs), Federally Qualified Health Centers (FQHCs) and specialty groups across Wyoming through our remote billing team. Each practice works with one billing lead who stays updated on Wyoming Medicaid bulletins, Noridian Medicare notices and changes from commercial insurers.
Stream RCM handles medical billing and coding in Wyoming through 8 steps. From patient registration to A/R follow up, our team checks claims, corrects errors and follows up on unpaid balances.
Patient
Insurance EligibilityMedical
Charge
Claim
Payment
Denial
A/R and PatientWe record each patient's legal name, date of birth, address, Wyoming Medicaid ID and every other active policy. If the patient has Medicare, private insurance or workers' compensation, we bill that payer before Medicaid. We then send the remaining balance to Wyoming Medicaid with details of the first payment. For patients with both Medicare and Medicaid, Medicare pays first and Medicaid may cover the remaining eligible costs.
We check each patient's Wyoming Medicaid coverage through the provider portal before every visit. Full Medicaid, Kid Care CHIP and Medicare Savings Programs cover different services. For example, the Specified Low-Income Medicare Beneficiary (SLMB) program only helps pay Medicare Part B premiums, not medical bills. We also check if the visit needs prior authorization.
We assign codes only when they match the provider's notes. That rule covers Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Wyoming Medicaid uses a Resource Based Relative Value Scale (RBRVS) fee schedule to pay for most physician and therapy services. The payment amount depends on the procedure code and modifier used.
We compare visit notes, records of procedures performed and superbills (visit charge sheets) with the charges in your system before claims go out. Missing charges can lead to late claims, and Wyoming Medicaid needs a clean claim no later than 12 months after the date of service. Reviewing charges before submission keeps them inside that window.
Wyoming Medicaid and Kid Care CHIP claims go to Acentra Health, the state's fiscal agent, through the provider portal or electronic data interchange (EDI). Original Medicare Part A and Part B claims go to Noridian under Jurisdiction F (JF). Blue Cross Blue Shield of Wyoming, Cigna, UnitedHealthcare and other commercial plans get their claims directly.
We record payments and adjustments from each electronic remittance advice (ERA) and explanation of benefits (EOB) separately and flag any underpayments for review. Providers generally cannot bill Medicaid patients for unpaid balances on covered services. Before any statement goes out, we check Qualified Medicare Beneficiary (QMB) status, because QMB members owe no Medicare cost sharing.
We review each denied claim for coding, coverage, authorization or enrollment errors, then correct it or file an appeal. For commercial plans, Wyoming prior authorization law requires fully insured insurers to decide standard requests within 5 calendar days and urgent ones within 72 hours. Since January 1, 2026, providers with 90% approval on at least 5 requests can earn a gold card exemption.
Unpaid claims are worked by deadline first, and our accounts receivable (A/R) team then looks at age and balance. Retroactive coverage follows its own rule. For example, a patient seen on January 15, 2025 wins eligibility on appeal on March 20, 2026. The standard 12 month deadline has passed, so the claim must reach Wyoming Medicaid within 6 months of the decision, by September 20, 2026.
Some practices choose to outsource medical billing services in Wyoming when staff salaries, software and training cost more than the outsourcing fee. Small rural offices may face this problem sooner because one employee often handles both front desk work and billing. Here is how the two options compare in 5 areas.
| Billing Area | Your Own Billing Team | Outsourced to Stream RCM |
|---|---|---|
| Staff Costs | Salaries, benefits, software and training | Fee based on monthly collections |
| Wyoming Medicaid 12 Month Limit | Staff monitor deadlines alongside daily billing work | Each claim flagged well before month 12 |
| Enrollment and Revalidation | Internal team tracks enrollment and renewal dates | Revalidation and NPI records tracked for each provider |
| Coding Reviews | Reviews depend on staff experience and internal processes | Codes checked against notes and National Correct Coding Initiative (NCCI) edits |
| Reporting | Reports depend on the practice's billing software | Regular reports on claims, denials and A/R |
Wyoming healthcare practices can choose one billing service or hand the full revenue cycle to Stream RCM.
We check claims for payer edits, send them to Acentra Health, Noridian or commercial plans and track payment.
Our certified coders assign CPT, HCPCS and ICD-10-CM codes from provider documentation and double check modifiers before billing.
Every denial is traced to its cause, corrected within the payer's deadline and logged to prevent repeat errors.
We line up open balances by filing deadline, age and amount, then call payers and check claim status until each claim closes.
Our credentialing team handles Wyoming Medicaid, Noridian Medicare, commercial contracts and revalidation dates.
Stream RCM works with practices in all 23 Wyoming counties. Each card shows the county’s Wyoming Medicaid enrolled members and its share of statewide enrollment for SFY 2025, from the WDH annual report.
Laramie County leads Wyoming with 14,106 Medicaid members, 15.8% of enrollment; Cheyenne Regional Medical Center anchors care.
Natrona County had 14,014 Wyoming Medicaid members, 15.7% of statewide enrollment; Banner Wyoming Medical Center serves Casper.
With 9,384 Medicaid members, Fremont County held 10.5% of enrollment; SageWest Health Care serves Lander and Riverton.
Campbell County Health in Gillette serves a county with 7,198 Wyoming Medicaid members, 8.1% of statewide enrollment.
Sweetwater County counted 6,393 Wyoming Medicaid members, 7.2% statewide; Memorial Hospital of Sweetwater County serves Rock Springs.
Sheridan Memorial Hospital serves Sheridan County, where 4,115 residents were Wyoming Medicaid members, 4.6% of statewide enrollment.
Cody Regional Health serves Park County, where 3,743 Wyoming Medicaid members made up 4.2% of statewide enrollment.
Evanston Regional Hospital serves Uinta County, whose 3,484 Wyoming Medicaid members made up 3.9% of statewide enrollment.
Albany County had 3,457 Wyoming Medicaid members, also 3.9% of statewide enrollment; Ivinson Memorial Hospital serves Laramie.
North Big Horn Hospital in Lovell serves Big Horn County and its 2,228 Medicaid members, 2.5% statewide.
Converse County counted 2,143 Wyoming Medicaid members, or 2.4% statewide; Memorial Hospital of Converse County serves Douglas.
Memorial Hospital of Carbon County in Rawlins serves a county with 2,108 Medicaid members, 2.4% of enrollment.
Goshen County had 2,091 Wyoming Medicaid members, 2.3% of enrollment, and Banner Health Community Hospital serves Torrington.
Star Valley Health in Afton serves Lincoln County, home to 1,974 Wyoming Medicaid members, 2.2% of enrollment.
Washakie County counted 1,271 Wyoming Medicaid members, or 1.4% of the state; Washakie Medical Center serves Worland.
These figures are client results Stream RCM reports across many specialties, not Wyoming results alone. Your results depend on payer mix, claim volume and current billing performance.
Wyoming Medicaid requires providers to submit claims within 12 months of the date of service. Claims submitted after this deadline may be denied.
Cigna claims follow the patient’s insurance plan rules, including coverage, prior authorization, and filing deadlines. Wyoming Medicaid follows state-specific billing rules, fee schedules, and coverage requirements. Providers must check each payer’s requirements before submitting claims to avoid denials.
Providers can enroll in Wyoming Medicaid through the Discover Your Provider (DyP) portal. They must submit the required documents, sign a provider agreement, and complete revalidation when required.
There is no official count of a medical biller shortage in Wyoming. The U.S. Bureau of Labor Statistics (BLS) projects 8% job growth for medical records specialists, the broader group that includes billers, from 2025 to 2035, with about 14,000 openings a year.
Medical billing companies usually charge a percentage of monthly collections. The cost depends on your specialty, claim volume, and services needed. Stream RCM pricing starts at 2.99% of monthly collections.
Look for a company with experience in Wyoming Medicaid, Medicare, and commercial insurance billing. Check its coding expertise, pricing, claim denial management, reporting, and client reviews before making a decision.
Tell us about your denied Wyoming Medicaid claims, enrollment gaps or slow commercial payments. Our team will review the issues and show where Stream RCM can help your practice.
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