Chiropractic insurance billing in Wyoming.

Medicare’s chiropractic rules are federal — the same in every state. Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940–98942), and ONLY when the care is active or corrective — which you signal with the AT modifier. Maintenance care, exams, X-rays, and any therapies performed by a chiropractor are not covered, so a properly executed ABN is essential before non-covered services. The full federal rules are in our chiropractic Medicare billing guide.

Part B claims in Wyoming are processed by Noridian Healthcare Solutions (JF) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Wyoming claims are measured against.

A Wyoming chiropractic or multi-specialty practice spends most of its commercial billing day with: Blue Cross Blue Shield of Wyoming; UnitedHealthcare; Cigna; Aetna; Mountain Health Co-Op; Medicare / Wyoming Medicaid (government payers).

Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

Wyoming is a comparatively LOW-delegation chiropractic market, and one notable specifics make it different from neighboring states.

• Cigna does NOT use American Specialty Health (ASH) in Wyoming. When Cigna expanded its ASH delegation for chiropractic/acupuncture/PT into new markets effective Sept. 1, 2023, an APTA editor’s note records that ‘Cigna has informed providers that it will not use American Specialty Health as a benefit management contractor in Wyoming’ — the State of Wyoming raised the issue at the legislative level (Wyoming Legislature interim-committee materials, June 2023). So, unlike many states where Cigna chiropractic routes to ASH (ashlink.com), Cigna chiropractic in Wyoming is handled directly by Cigna — verify on the member’s card.
• Blue Cross Blue Shield of Wyoming (BCBSWY) — the dominant commercial carrier — manages chiropractic/physical-medicine prior authorization IN-HOUSE through its own provider tools (Availity Authorization Pre-Check / BCBSWY precertification), not through a third-party chiropractic-network manager.
• UnitedHealthcare members in Wyoming follow UHC’s national pattern: chiropractic/outpatient-therapy authorization and Medicare Advantage prior authorization are managed through Optum / Optum Physical Health (entered via the UnitedHealthcare Provider Portal, adjudicated in Optum systems).
• Other carriers active in Wyoming — Aetna and Mountain Health CO-OP — administer chiropractic under their own plan rules; some national Aetna/Anthem product lines may still route chiropractic to ASH even though local plans do not. BOTTOM LINE: always verify on the member’s ID card/portal whether chiropractic is handled by the health plan directly (typical for BCBSWY, and — unusually — for Cigna in Wyoming) or carved out to Optum (UHC) or ASH (some national Aetna/Anthem plans), because that determines where credentialing, prior auth/treatment-plan submission, and claims go; misrouting is a leading denial cause. Workers’-comp chiropractic in Wyoming goes through the DWS Workers’ Compensation Division / CorVel under the state WC fee schedule; auto/Med-Pay through the member’s auto carrier.

What actually trips up chiropractic billing in Wyoming:

• MEDICAID generally does NOT cover chiropractic. Wyoming Medicaid eliminated chiropractic as a covered benefit effective April 1, 2021; per chiropractic-profession guidance the program pays chiropractic only when MEDICARE is the primary payer (i.e., on a Medicare crossover), so a chiropractor treating a Medicaid-ONLY member should expect non-coverage — verify current coverage and any EPSDT/under-21 pathway in the live manual before treating, and never assume a commercial-style chiropractic benefit exists under Wyoming Medicaid.
• The Cigna/ASH carve-out that applies elsewhere does NOT apply in Wyoming — Cigna confirmed it will NOT use ASH here, so send Cigna chiropractic auths/claims to Cigna directly, while UnitedHealthcare routes through Optum via the UHC portal and BCBSWY handles chiropractic in-house; sending the auth or claim to the wrong entity gets it bounced; confirm the delegated entity on the member’s card before submitting.
• Visit caps / treatment-plan & medical-necessity rules — expect annual visit limits and treatment-plan/re-evaluation requirements with a clear shift from active/corrective to ‘maintenance’ care (maintenance is typically non-covered); plan caps vary, so check the specific Summary of Benefits, and note that BCBSWY and UHC/Optum both require prior authorization/medical-necessity review beyond an initial allowance.
• Modifier/coding quirks — on Medicare/MA spinal manipulation (98940-98942) the AT modifier is required for active/corrective care, with correct GA/GY/GZ usage; modifier -25 is required for a separately identifiable E/M billed with a same-day manipulation, and proper -59/-XU when distinct services are billed; remember Medicare/MA covers ONLY manipulation, not the DC’s exams, x-rays, or therapies.
• WYOMING CHIROPRACTIC SCOPE is broad — under Wyo. Stat. Ann. 33-10-101 et seq. (Chiropractic Practice Act), Wyoming chiropractors may use manipulative, manual, mechanical, physiotherapeutic and clinical-nutritional methods and may perform venipuncture, acupuncture, and diagnostic x-rays (with referral rights for advanced imaging) but may NOT perform surgery, prescribe legend drugs, practice obstetrics, or administer x-ray therapy — billable scope is wide, but coverage/benefit limits (not scope) drive most denials.
• WORKERS’ COMP chiropractic is paid by the DWS Workers’ Compensation Division / CorVel under the state WC medical fee schedule and may require preauthorization — not the commercial rules; bill CMS-1500/UB-04 with notes, and remember there is no statutory provider filing deadline or late-payment penalty (state-fund system) but payment requires a compensable, accepted claim.
• Insurance-code jurisdiction — any entity providing coverage in Wyoming for medical, surgical, CHIROPRACTIC, physical-therapy and related expenses is subject to the Wyoming Insurance Department (Title 26), and the 45-day prompt-pay rule (Wyo. Stat. Ann. 26-15-124) with attorney-fee/10%-interest exposure is a useful lever on unreasonably delayed clean-claim payment. Not legal advice — verify benefits and current rules per payer.

Largely CONTRACT/PAYER-SET, not fixed by a single Wyoming statute — the initial-claim filing window is whatever the participating-provider agreement or the payer’s provider manual specifies. In practice Wyoming commercial/private payers commonly use a 90-180 day window from the date of service (some plans allow up to 12 months); always confirm the exact number in your contract or the payer’s provider manual, since the dominant Wyoming carriers each set their own deadline — Blue Cross Blue Shield of Wyoming (BCBSWY, the largest commercial carrier), UnitedHealthcare, Cigna, Aetna, and Mountain Health CO-OP.

Wyoming does NOT set a minimum provider-submission floor, but its insurance code regulates how fast the PLAN must act: under Wyoming’s prompt-pay statute, Wyo. Stat. Ann. 26-15-124(a), a claim under a life, accident or health insurance policy must be rejected or accepted and PAID within FORTY-FIVE (45) DAYS after the insurer receives the proofs of loss and supporting evidence (property/casualty claims likewise within 45 days of the claim and supporting bills); if the company’s refusal to pay a covered loss is found unreasonable or without cause, the court may award the claimant a reasonable attorney’s fee plus interest at 10% per year, and an accident/health claim’s 45-day clock is tolled if a genuine question on validity/amount is referred to the Wyoming state medical peer review committee.

That 45-day rule is the insurer’s PAYMENT clock, not the provider’s SUBMISSION deadline, which remains contractual. As of 2025-2026; verify the exact window per payer and contract before relying on any single number.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service claim. Set by the Social Security Act (Section 1842(b)(3)(B)) and CMS (Medicare Claims Processing Manual, Ch. 1), not by Wyoming.

Medicare Advantage plans set their own deadlines (often similar, up to ~12 months) — confirm per plan. Note for chiropractic: Medicare/MA covers ONLY manual spinal manipulation to correct a documented subluxation (CPT 98940-98942) with the AT modifier on active/corrective-care claims; the chiropractor’s exams, x-rays, extraspinal manipulation (98943), and therapy modalities are NOT covered.

UnitedHealthcare/Optum Medicare Advantage now requires prior authorization for Medicare-covered chiropractic (initial evaluation generally exempt; an initial allowance of follow-up visits permitted before clinical review, anything beyond reviewed for medical necessity), and ‘routine’ supplemental chiropractic offered on some MA plans is a separate, non-Medicare benefit — confirm per plan and the member’s ID card.

Wyoming Medicaid: the timely-filing limit is 365 DAYS (1 year) from the date of service to submit a claim, per the Wyoming Medicaid Provider FAQs / provider manual (claims-processing administered by the state’s fiscal agent). Related rules: if a claim ADJUSTMENT is needed it must be made within 6 MONTHS (180 days) of the date of service, while a VOID is accepted at any time without a timely-filing limit. For MEDICARE CROSSOVER claims, the limit is 12 months (365 days) from the date of service OR six

• months (180 days) from the date of the Medicare payment, whichever is LATER. The submission date is the date the claim is received by Wyoming Medicaid (its fiscal-agent claims processor). IMPORTANT CHIROPRACTIC CAVEAT: Wyoming Medicaid ELIMINATED chiropractic services as a covered benefit effective April 1, 2021 (a state budget reduction); per chiropractic-profession guidance, Wyoming Medicaid will generally pay chiropractic only as the secondary/crossover payer when MEDICARE is primary — so for most Medicaid-only members, chiropractic manipulation is non-covered (verify current coverage and any EPSDT/under-21 exception in the live provider manual before treating). Confirm the current manual before relying on these numbers.

Wyoming Workers’ Compensation has NO fixed statutory number-of-days deadline requiring a medical PROVIDER to SUBMIT a bill, and — because Wyoming runs an EXCLUSIVE state-fund (monopolistic) system administered by the Department of Workforce Services (DWS), Workers’ Compensation Division (medical bills processed by the Division’s third-party bill-review contractor, CorVel) — there is no statutory late-payment penalty regime of the kind found in private-carrier states. Practitioner guidance summarizing the statute and the DWS Rules notes there are no time-limit provisions in the statute or rules of procedure for the PAYMENT of medical bills, and no late-payment penalties, because Wyoming uses a state fund. Reimbursement is governed by the DWS-adopted Wyoming Workers’ Compensation Medical Fee Schedule (Wyo. Admin. Code / DWS WC Rules, ch. 9 et seq.); bills must be reasonable, necessary, and directly related to the work injury, submitted on a CMS-1500 (HCFA) or UB-04 with the supporting medical notes, to CorVel (mail: State of Wyoming, PO Box 2087, Portland, OR 97208-2087; or EDI). Treatment may require PREAUTHORIZATION under the DWS preauthorization process. Separately, the injured WORKER’S own claim is time-barred: a claim for benefits must generally be filed within ONE

• YEAR after a non-fatal injury is diagnosed/discovered (and within 3 years from the date of last injurious exposure for occupational disease), per Wyo. Stat. Ann. 27-14-601 et seq.; the Division performs an initial benefit review within 15 days and issues a final determination (or a request for more information, then a final determination within 45 days of that request). PRACTICAL NORM: although no statutory provider filing deadline exists, submit complete CMS-1500/UB-04 bills with records PROMPTLY — payment requires an accepted/compensable claim, current fee-schedule pricing, and (where applicable) preauthorization. Confirm the current DWS Rules and fee schedule before relying on these.

Wyoming is an AT-FAULT (tort) state — it is NOT a no-fault state and has NO mandatory PIP. There is NO fixed statutory number-of-days deadline requiring a provider to SUBMIT medical bills to an auto carrier. First-party medical coverage is OPTIONAL Medical Payments (Med-Pay) a driver may buy; any bill-submission timeframe is set by the individual auto policy (commonly a 1-, 2-, or 3-year window), not by statute — submit promptly per the policy’s notice/proof-of-loss terms.

Once a clean first-party claim is received, the insurer’s PAYMENT clock is governed by Wyoming’s prompt-pay statute, Wyo. Stat. Ann. 26-15-124 (accept/reject and pay within 45 days of proofs of loss and supporting evidence; property/casualty within 45 days of the claim and supporting bills; potential attorney’s fee plus 10%/year interest where the refusal to pay a covered loss is unreasonable or without cause).

The underlying third-party liability (bodily-injury) claim is governed by Wyoming’s FOUR-YEAR personal-injury statute of limitations (Wyo. Stat. Ann. 1-3-105(a)(iv)); on a liability/lien basis, bills are typically presented at settlement.

Wyoming’s minimum auto liability is 25/50/20. Confirm each Med-Pay policy’s notice and submission terms.