(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.