Wyo. Code R. 044-0002-72
Effective Date: 11/15/2024 to Current
Rule Type: Current Rules & Regulations
Reference Number: 044.0002.72.11152024
Section 1. Authority. This Chapter is promulgated by authority of and pursuant to W.S. §§16-3-101 through 16-3-106, W.S. §§ 26-55-101 et seq.
Section 2. Scope. This regulation sets forth the requirements and procedures for health insurers and contracted utilization review entities, as defined in W.S. § 26-55-102, that are conducting the business of insurance in this state for prior authorization requirements of W.S. §§ 26-55-101 et seq.
Section 3. Definitions. The definitions provided in W.S. 26-55-102 shall apply to the interpretation of this regulation.
(a) Each health insurer or contracted utilization review entity engaged in the business of insurance in this state which require some or all policy benefits to undergo prior authorization, shall provide a report containing the categories of information identified in W.S. § 26-55-103(d) by:
(i) Providing the report directly to the insurance commissioner upon request; and
(ii) Posting the report on the insurer's or contracted utilization review entity's website. The location of the report shall be clearly indicated on the home page of the reporting health insurer's or reporting contracted utilization review entity's website.
(b) The report required under Subsection (a) above shall be made on a form prescribed by the Commissioner. The required form, Prior Authorization Statistics Reporting Form, is located at http://doi.wyo.gov.
(c) Beginning with the initial report on January 30, 2025, the report shall be made available on the health insurer's or contracted utilization review entity's website on April 30, July 30, October 30, and January 30 of each calendar year.
(d) Each reporting health insurer or reporting contracted utilization review entity shall maintain and make available to the public on their website the most recent four (4) reports that have been filed.
(e) Every year all health insurers or contracted utilization review entities shall file an annual report with the Commissioner on or before March 1, indicating where the required reports can be found and the dates they were updated. The annual report shall be filed a form prescribed by the Commissioner. The required form, Annual Prior Authorization Reporting Form, is located at http://doi.wyo.gov.
Section 5. Disclosure Records Retention. Health insurers or contracted utilization review entities shall keep and maintain all records regarding compliance with W.S. § 26-55-101 et seq. and this regulation for a minimum of five (5) years and shall make that information available to the commissioner upon reasonable request.