048.0037.3.8
Ch. 3, § 8. Provider Records
Cite as Medicaid Rules, Ch. 3, § 8
(a) A provider shall collect and maintain medical and financial data, records, and information as necessary to provide services.
(b) A provider shall develop and maintain a record keeping system that includes a separate record for each client served.
(c) A provider shall maintain medical and financial records, including information regarding dates of service, diagnoses, services furnished, and claims, for at least six (6) years after the end of the state fiscal year in which payment for services was rendered.
(i) If any litigation, claim, audit or other action involving the records is initiated before the expiration of the six (6) year period, the records shall be maintained until the litigation, claim, audit or other action and any subsequent administrative or legal proceedings are resolved.
(ii) Such records shall be maintained for three (3) years in hard-copy, after which they may be maintained on micro-fiche, micro-film, or electronically.
(d) A provider shall make its financial records and the client's medical records available upon request to representatives of the Department, the United States Department of Health and Human Services, Health Care Finance Administration (HCFA), the Comptroller General of the United States, the Wyoming Attorney General, or the Medicaid Fraud Control Unit (MFCU).
(e) The Department may copy provider records as necessary to fulfill its authorized functions.
(f) The refusal of a provider to make financial or medical records available and accessible shall result in:
(i) The immediate suspension of all Medicaid payments to the provider including payments for services furnished after the date of the request. No payments shall be made to the providers until the Department determines that adequate records have been produced and maintained; and
(ii) All Medicaid payments made to the provider during the period for which records supporting such payments are not produced shall be repaid to the Department within ten (10) days after written request for such repayment.