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Wyoming · Through 2026 Budget Session; as of 2026-07-01

Wyo. Stat. § 26-55-104: Persons qualified to make adverse determinations.

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Where this section sits in the code
  1. TITLE 26 - INSURANCE CODE
  2. CHAPTER 55 - ENSURING TRANSPARENCY IN PRIOR AUTHORIZATION ACT

(a) Each health insurer or contracted utilization review entity shall ensure that all adverse determinations are made by a physician or other appropriate licensed health care provider who has:

(i) Sufficient medical knowledge in an applicable practice area or specialty;

(ii) Knowledge of the coverage criteria;

(iii) Unless otherwise required under Wyoming law, a current and unrestricted license to practice within the scope of their profession in a state, territory, commonwealth of the United States or the District of Columbia;

(iv) Knowledge of the applicable person's medical history and diagnosis.

Collected 2026-09-04T00:16:32Z. Source file · JSON

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