Wyo. Stat. Ann. tit. 26, ch. 56 — Health Care Provider Credentialing | Wyoming Statutes Annotated — Wyoming

Wyo. Stat. Ann. § 26-56-101 Definitions.

(a) As used in this chapter: (i) "Applicant" means a health care provider who submits an application to a health carrier to become credentialed as a participating health care provider in one (1) or more of the health carrier's provider networks; (ii) "Application" means an applicant's most recent application to become credentialed by a health carrier as a participating health care provider in one (1) or more of the health carrier's provider networks; (iii) "Completed credentialing application" means a credentialing application that is free of defects and contains all of the information that, when later supplemented by verification and documentation gathered by the health carrier during the primary source verification process, is necessary for the health carrier to make a credentialing decision; (iv) "Credentialing" means the process by which a health carrier or its designee collects information concerning an applicant, assesses whether the applicant satisfies the requirements to become a participating health care provider in one (1) or more of the health carrier's provider networks, verifies all information submitted by the applicant and approves or denies the applicant's application; (v) "Health carrier" means as defined by W.S. 26-13-303(a)(iii) and shall not mean pharmacy benefit managers as defined by W.S. 26-52-102(a)(vii).

Wyo. Stat. Ann. § 26-56-102 Health care provider credentialing; requirements.

(a) Within seven (7) calendar days after a health carrier receives an application for credentialing, the health carrier shall provide the applicant notice of receipt of the application in written or electronic form and contact information for the person reviewing the application. After receiving an application, a health carrier shall determine whether the application is complete. If the health carrier determines that the application is incomplete, the health carrier shall notify the applicant in writing or by electronic means that the application is incomplete within thirty (30) calendar days after the date the health carrier received the application. The notice shall describe the items that are required to complete the application. The health care provider shall submit a completed credentialing application within thirty (30) calendar days of receiving the notice. Failure of the health care provider to submit a completed credentialing application within thirty (30) days of receiving the notice shall restart the timelines in this subsection. (b) A health carrier shall conclude the process of credentialing an applicant within sixty (60) calendar days after the health carrier receives the applicant's application. The sixty (60) calendar day period shall pause if a health care provider receives notification that their application is incomplete and shall resume after the health carrier verifies that the health care provider has resubmitted a completed credentialing application. A health carrier shall provide each applicant written or electronic notice of the outcome of the applicant's credentialing at the conclusion of the credentialing process. (c) If an applicant becomes credentialed as a participating health care provider in a health carrier's network and a fully executed contract between the health care provider and the health carrier is in effect prior to covered services being provided, the health carrier shall reimburse the applicant for all covered reimbursable health care services provided by the applicant beginning with the date the health carrier received a completed credentialing application from the applicant, unless otherwise preempted by federal law. (d) A health carrier shall not be required to approve any application for credentialing, except as provided by W.S. 26-22-503.