We work your aged and denied claims against Wyoming's own payer rules, inside the EHR you already use, and we are paid on what comes back.
Not sure where your balances stand? Start with a free audit.
Wyoming payers
A Wyoming practice is paid mainly by five sources: Medicare through Noridian, Wyoming Medicaid, Blue Cross Blue Shield of Wyoming, the state workers' compensation fund, and TRICARE. Each sets its own clock and its own rules for a corrected claim. Aged AR is recovered by working each balance against the rule that actually governs it, not a national average.
Part A and Part B claims from Wyoming go to Noridian Healthcare Solutions, the Jurisdiction F Medicare Administrative Contractor. The initial claim must be filed within 12 months of the date of service. After that, the claim is gone, regardless of how clean it was.
Source: CMS MAC directory · 42 CFR 424.44
Claims must be submitted and finalized within 12 months of the date of service or discharge, whichever is later. That second word matters. A claim sent in month 11 that comes back for a correction can run out of time before the corrected version is processed. Sending it is not enough; it has to be closed inside the window.
Medicare-Medicaid crossovers have their own window: 12 months from the date of service or 6 months from the Medicare payment date, whichever is later. Medicaid asks providers to wait 45 days after Medicare's payment date before billing it for coinsurance, deductible or copay.
A current issue posted by Wyoming Medicaid: UHC Advantage and D-SNP primary claims billed to Medicaid as secondary have been denying with Error Code 1058 when the Part B deductible on the claim exceeds the annual amount.
Source: Wyoming Medicaid Rules, Chapter 3 · wyomingmedicaid.com, What's New
BCBSWY held 74.4% of Wyoming's large-group market in 2016, the most recent GAO figure. Its filing limit is one year from the date of service, and shorter for some employer groups. The plan encourages submission within 60 days.
Several billing sites list 60 days as the limit. It is the recommendation, not the limit. The real risk is the group with a shorter contract, which is why limits are checked per group.
Source: bcbswy.com provider update · GAO, 2016 market data
Wyoming is a monopolistic state. Most employers are covered through the Workers' Compensation Division of the Department of Workforce Services, not private carriers. Bills go to CorVel for processing, with the supporting medical notes and a CMS-1500 or UB-04.
Billing questions go to CorVel. Compensability questions go to the Division. Claim status is in PIERS. Sending a compensability problem to CorVel wastes weeks.
Source: doi.wyo.gov · dws.wyo.gov, Medical Providers page and FAQ
Wyoming sits in the TRICARE West Region, administered by TriWest Healthcare Alliance since 1 January 2025.
Source: tricare.mil
Engagement
The method is the same everywhere; see how AR recovery works. What changes for a Wyoming practice is the order claims are worked in, because Wyoming's rules decide which balances expire first. We work remotely, inside the EHR you already use.
Every balance is sorted against the deadlines in the table below. BCBSWY limits are checked per employer group, not assumed to be one year.
Wyoming Medicaid claims are ranked by how much of the 12-month window remains to get them finalized, not just submitted. A claim likely to need correction goes first.
Crossover balances are held until 45 days have passed from Medicare's payment date, then billed to Medicaid, so they are not rejected as premature.
Comparison
A process comparison drawn from one engagement outside Wyoming. Not a record of a Wyoming practice and not a promise of outcome.
| Area | Before | With Quilven |
|---|---|---|
| Rejection ownership | No one was assigned to the rejection queue, so rejected claims sat untouched for close to a year. | Rejections are worked within four to five days, while the claim is still inside its filing window. |
| Coordination of benefits | Other-coverage records went stale because patients were never called, and the same claims kept denying. | Medicare-Medicaid crossovers are held until the 45-day wait has passed, then billed. Other COB is fixed by calling the patient. |
| Payer routing | Claims were sent to a parent plan when a subsidiary with its own claims unit and IDs was responsible. | The responsible payer entity is confirmed before submission, including CorVel for state-fund workers' comp bills. |
| Eligibility | Visits went ahead on terminated coverage and the claims were sent regardless. | Coverage is checked before the visit rather than discovered at denial. |
| Member and group IDs | A single formatting error in a member ID stayed in the record for months. | Demographic fields are matched to the payer's record before the claim leaves. |
| Lab claim attribution | The group NPI was entered where the ordering physician's belonged, with a CLIA level that did not fit the code. | The individual physician's NPI is in box 17 and the CLIA level fits the code billed. |
| Modifiers | Waived lab tests went out without QW, and 25, 59 and RT were left off where required. | Modifiers are checked by code family before submission. |
| Timely filing | Rejections surfaced long after the fact, with nothing on file to prove the original submission. | Deadlines are tracked per payer, including BCBSWY group-level limits and Medicaid's submitted-and-finalized rule, with proof of submission kept. |
Which of these applies to your claims is a question the audit answers.
Deadlines
A Wyoming claim is recoverable if its payer's window is still open, or if you can prove it was filed on time. The table lists each window. Anything inside one is workable now. Anything past one needs proof of timely submission, or it is a write-off. See which Wyoming claims are still workable.
| Payer | Deadline | Source |
|---|---|---|
| Medicare, initial claim | 12 months from date of service | 42 CFR 424.44 |
| Medicare, redetermination | 120 days from receipt of the initial determination | 42 CFR 405.942 |
| Wyoming Medicaid | Submitted and finalized within 12 months of service or discharge, whichever is later | WY Medicaid Rules ch. 3 |
| Medicare-Medicaid crossover | 12 months from service or 6 months from Medicare payment, whichever is later | wyomingmedicaid.com |
| BCBSWY | 1 year from date of service; some groups shorter | bcbswy.com |
Last checked: 27 Sep 2026
You can run your claims against these deadlines in the browser, with no patient data.
W.S. 26-15-124(a) requires health insurers to accept or reject and pay a claim within 45 days of receiving proof of loss, except for claims referred to the state medical peer review committee.
Under subsection (c), interest at 10% a year and attorney's fees apply only when a court finds the refusal to pay was unreasonable or without cause. There is no automatic interest on a late claim. This is separate from Wyoming's 2024 pharmacy prompt-pay law, which covers pharmacy claims only.
Case study
One AR recovery engagement, at a family medicine practice in Minnesota, not Wyoming. Shown for method. Individual results vary. One engagement is not a forecast.
The scope was 245 claims. Rejections had gone unworked for about a year, and no one owned the queue.
Found: roughly $40,000 to $50,000 in billed charges sitting unworked in the rejection queue.
The front desk was the source of most of the problem: stale coverage, wrong member IDs and missed eligibility checks accounted for 70% of the denials.
One limit held. A commercial payer's 90-day filing window had closed on most of the affected claims, and there was no proof of submission on file, so those could not be appealed.
Recovered: about $5,500, across 50 to 55 paid claims, the bulk within 45 to 50 working days.
In their words
What you have provided for me was a detailed of things that are going wrong that needed to change in our practice.
I appreciate that you did an audit and found out the root causes of a lot of my problems which are preventable.
I appreciate the professionalism, the courtesy, the knowledge.
After the audit the practice changed how it runs: eligibility verified before arrival, no more walk-ins, every patient checked the night before.
Pricing
Same pricing as every Quilven engagement, with nothing Wyoming-specific. See the full pricing detail.
12 to 15%
of the recovered amount
No fee on what is not recovered. Where a practice lands in the range depends on claim volume, age of the inventory, and payer mix.
3 to 5%
of collections by monthly volume
A $500 monthly minimum applies. The rate moves with monthly volume, not with headcount on your side.
$150 to $250
per provider per payer
Priced per enrollment so you can see exactly what each payer application costs before it starts.
Fit
Recovery work does not require a system swap. We integrate with 30+ EHRs and practice management systems and work inside the one you already have. No data migration, no parallel system, no change to how your staff enters a charge or checks a patient in. If your team is trained on your current software, that training stays valid.
This matters because the usual objection to outside AR help is that it turns into an implementation project. It does not here. Quilven is a managed service, not software. There is no proprietary platform you are asked to adopt and no license to renew, so the engagement can start on your existing inventory rather than after a build-out.
What you do get is visibility. Apex is our client dashboard, and it shows in real time:
Apex reads the work we are doing in your system. It is a window, not a replacement, so if the engagement ends your records and workflows are exactly where they were.
Company
Quilven is a managed revenue cycle service. Not software, not an EHR, and not a proprietary platform you have to adopt. We work inside the system your practice already uses, across 30+ integrations, with no data migration and no workflow change. Our clients are independent practices with 3 to 25+ providers.
Pricing is straightforward. AR recovery is 12 to 15 percent of the recovered amount. Medical billing is 3 to 5 percent of collections by monthly volume, with a $500 monthly minimum. Credentialing is $150 to $250 per provider per payer.
The entry point is a free RCM audit. It takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, so the first thing you get from us is a diagnosis you can act on with or without us.
We lead with method and evidence rather than tenure. Quilven was founded in 2025 by Raief Shick and works from 159 4th Ave N, Suite 100, Nashville, TN 37219. The entity is registered in Wyoming. Reach us at (202) 490-9406 or info@quilven.com.
QUILVEN, LLC is registered in Wyoming. Our office is in Nashville, and Wyoming practices are served remotely, inside their own EHR.
Fit
Independent Wyoming practices with 3 to 25+ providers that have Medicaid, BCBSWY or Medicare claims running toward their deadlines, and no one with the time to work them before they close.
If the backlog is a one-time problem, a fixed-scope cleanup of aged claims may fit better than an ongoing engagement. If you want a number first, estimate what your aged AR is worth.
It is not for hospitals or critical access hospitals billing facility claims.
At a glance
FAQ
Next step
The audit takes 3 to 5 business days and returns a line-by-line recoverable revenue estimate by payer, plus the repeating root causes behind your denials. We only need aging totals to begin. No patient data, no contract, no obligation to work with us afterward. If your aging is healthy we will tell you that.
Answer three questions below and book a line-by-line audit of your Wyoming claims.
Pick the one that hurts most. We start there.
A round number is fine. We verify it in the audit.
Just you, or a group. Either is welcome.
No patient data. We only need aging totals to start.
(202) 490-9406 · info@quilven.com · Book 15 minutes