Persons qualified to make adverse determinations.

Wyo. Stat. Ann. § 26-55-104
in effect
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(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.
Source: WY Statutes (Official Site)URL: https://wyoleg.gov/statutes/compress/title26.pdfFetched: 10/4/2026

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