§ 26-56-102 — Health care provider credentialing; requirements

Wyoming § 26-56-102

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

Text

(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.