§ 26-55-104 — Persons qualified to make adverse determinations

(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.