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25LSO-0032
ORIGINAL House
Bill No
.
HB0082
ENROLLED ACT NO. 12,
HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 General Session
AN ACT relating to the insurance code; requiring health insurance carriers to follow specified guidelines regarding health care provider credentialing; specifying that health carriers shall not be required to violate or fail to meet requirements of a nationally recognized accrediting entity; providing definitions; specifying applicability; requiring rulemaking; and providing for effective dates.
Be It Enacted by the Legislature of the State of Wyoming:
Section 1
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W.S. 26
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56
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101 and 26
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56
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102 are created to read:
CHAPTER 56
HEALTH CARE PROVIDER CREDENTIALING
26
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56
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101.
Definitions.
(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
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13
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303(a)(iii) and shall not mean pharmacy benefit managers as defined by W.S. 26
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52
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102(a)(vii).
26
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56
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102.
Health care provider credentialing; requirements.
(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
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22
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503.
Section 2
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The department of insurance shall promulgate rules providing for a uniform credentialing application that shall be used by applicants and health carriers. Dental and vision insurance are exempt from using the uniform application.
Section 3
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Nothing in this act shall require a health
carrier to violate or fail to meet a standard or requirement of a nationally recognized accrediting entity.
Section 4
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This act shall apply to applications for credentialing submitted to health carriers on or after July 1, 2025.
Section 5
.
(a)
Except as otherwise provided by subsection (b) of this section, this act is effective July 1, 2025.
(b)
Sections 2 and 5 of this act are effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.
(END)
Speaker of the House
President of the Senate
Governor
TIME APPROVED: _________
DATE APPROVED: _________
I hereby certify that this act originated in the House.
Chief Clerk
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