Wyoming Medical

Medicare of Wyoming

  • Direct Link
  • Claims processed through Noridian (800) 967-7902
  • Requires Noridian Submitter ID in Claimstaker
  • Payer ID – 03602
  • Enrollment must be done by the provider on-line at Noridian https://noridian.totalonboarding.com. The CMS form needs to be done as well and faxed to Noridian.
  • This enrollment is for the setup of claims and ERA’s

CMS Enrollment Form

Medicaid of Wyoming  

  • Direct Link
  • Claims Processed through ACS EDI Gateway
  • Call (800) 672-4959 as early as 6 business days after form submission to check status of enrollment  
  • Both ACS forms below must be completed in order to set up electronically
  • When you are enrolled for WY Medicaid you are enrolled for DME, Just set up in Claimstaker
  • Payer ID – WYMCD (Regular Medicaid)
  • Payer ID – WYMDE (Medicaird DME)

ACS Trading Partner Agreement

ACS Authorization Form — Only the first page of this form needs to be filled out and sent in

BCBS of Wyoming

  • Direct Link
  • Claims processed through Noridian (800) 967-7902
  • Requires Noridian Submitter ID in Claimstaker
  • Payer ID – 00960
  • Enrollment must be done by the provider on-line at Noridian https://noridian.totalonboarding.com. The TPA form needs to be done as well, see instructions below.

BCBS of Wyoming Trading Partner Agreement

  • Required for any of our new providers who wish to send to BCBS of WY
  • Form must be competed, mailed to Tim J. Crilly (address on the form), Tim J. Crilly will sign the form and mail back to the provider, then the provider must mail completed agreement to Noridian.

BCBS of WY Trading Partner Agreement

National Payers Requiring Enrollment

  • Railroad Medicare
  • DMERC (Region D)
  • ASHN

National Enrollment Forms