§ 26-56-101 — Definitions

Wyoming § 26-56-101

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 56: HEALTH CARE PROVIDER CREDENTIALING

Text

(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).