Wyoming 2025 Regular Session

Wyoming House Bill HB0082 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	ORIGINAL HOUSE
2		-	BILL NO. HB0082
3		-	ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
4		-	SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
5		-	2025 GENERAL SESSION
	1	+	2025
	2	+	STATE OF WYOMING
	3	+	25LSO-00321HB0082
	4	+	HOUSE BILL NO. HB0082
	5	+	Provider enrollment-standards.
	6	+	Sponsored by: Joint Labor, Health & Social Services Interim
	7	+	Committee
	8	+	A BILL
	9	+	for
	10	+	1 AN ACT relating to the insurance code; requiring health
	11	+	2 insurance carriers to follow specified guidelines regarding
	12	+	3 health care provider credentialing; specifying that health
	13	+	4 carriers shall not be required to violate or fail to meet
	14	+	5 requirements of a nationally recognized accrediting entity;
	15	+	6 providing definitions; specifying applicability; requiring
	16	+	7 rulemaking; and providing for effective dates.
	17	+	8
	18	+	9
	19	+	10
	20	+	11. W.S. 26-56-101 and 26-56-102 are created
	21	+	12 to read:
	22	+	13
	23	+	14 CHAPTER 56
	24	+	15 HEALTH CARE PROVIDER CREDENTIALING 2025STATE OF WYOMING25LSO-00322HB0082
6	25		1
7		-	AN ACT relating to the insurance code; requiring health
8		-	insurance carriers to follow specified guidelines regarding
9		-	health care provider credentialing; specifying that health
10		-	carriers shall not be required to violate or fail to meet
11		-	requirements of a nationally recognized accrediting entity;
12		-	providing definitions; specifying applicability; requiring
13		-	rulemaking; and providing for effective dates.
14		-	Be It Enacted by the Legislature of the State of Wyoming:
15		-	Section 1. W.S. 26-56-101 and 26-56-102 are created
16		-	to read:
17		-	CHAPTER 56
18		-	HEALTH CARE PROVIDER CREDENTIALING
19		-	26-56-101. Definitions.
20		-	(a) As used in this chapter:
21		-	(i) "Applicant" means a health care provider who
22		-	submits an application to a health carrier to become
23		-	credentialed as a participating health care provider in one
24		-	(1) or more of the health carrier's provider networks;
25		-	(ii) "Application" means an applicant's most
26		-	recent application to become credentialed by a health
27		-	carrier as a participating health care provider in one (1)
28		-	or more of the health carrier's provider networks;
29		-	(iii) "Completed credentialing application"
30		-	means a credentialing application that is free of defects
31		-	and contains all of the information that, when later
32		-	supplemented by verification and documentation gathered by
33		-	the health carrier during the primary source verification ORIGINAL HOUSE
34		-	BILL NO. HB0082
35		-	ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
36		-	SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
37		-	2025 GENERAL SESSION
38	26		2
39		-	process, is necessary for the health carrier to make a
40		-	credentialing decision;
41		-	(iv) "Credentialing" means the process by which
42		-	a health carrier or its designee collects information
43		-	concerning an applicant, assesses whether the applicant
44		-	satisfies the requirements to become a participating health
45		-	care provider in one (1) or more of the health carrier's
46		-	provider networks, verifies all information submitted by
47		-	the applicant and approves or denies the applicant's
48		-	application;
49		-	(v) "Health carrier" means as defined by W.S.
50		-	26-13-303(a)(iii) and shall not mean pharmacy benefit
51		-	managers as defined by W.S. 26-52-102(a)(vii).
52		-	26-56-102. Health care provider credentialing;
53		-	requirements.
54		-	(a) Within seven (7) calendar days after a health
55		-	carrier receives an application for credentialing, the
56		-	health carrier shall provide the applicant notice of
57		-	receipt of the application in written or electronic form
58		-	and contact information for the person reviewing the
59		-	application. After receiving an application, a health
60		-	carrier shall determine whether the application is
61		-	complete. If the health carrier determines that the
62		-	application is incomplete, the health carrier shall notify
63		-	the applicant in writing or by electronic means that the
64		-	application is incomplete within thirty (30) calendar days
65		-	after the date the health carrier received the application.
66		-	The notice shall describe the items that are required to
67		-	complete the application. The health care provider shall
68		-	submit a completed credentialing application within thirty
69		-	(30) calendar days of receiving the notice. Failure of the ORIGINAL HOUSE
70		-	BILL NO. HB0082
71		-	ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
72		-	SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
73		-	2025 GENERAL SESSION
74	27		3
75		-	health care provider to submit a completed credentialing
76		-	application within thirty (30) days of receiving the notice
77		-	shall restart the timelines in this subsection.
78		-	(b) A health carrier shall conclude the process of
79		-	credentialing an applicant within sixty (60) calendar days
80		-	after the health carrier receives the applicant's
81		-	application. The sixty (60) calendar day period shall pause
82		-	if a health care provider receives notification that their
83		-	application is incomplete and shall resume after the health
84		-	carrier verifies that the health care provider has
85		-	resubmitted a completed credentialing application. A health
86		-	carrier shall provide each applicant written or electronic
87		-	notice of the outcome of the applicant's credentialing at
88		-	the conclusion of the credentialing process.
89		-	(c) If an applicant becomes credentialed as a
90		-	participating health care provider in a health carrier's
91		-	network and a fully executed contract between the health
92		-	care provider and the health carrier is in effect prior to
93		-	covered services being provided, the health carrier shall
94		-	reimburse the applicant for all covered reimbursable health
95		-	care services provided by the applicant beginning with the
96		-	date the health carrier received a completed credentialing
97		-	application from the applicant, unless otherwise preempted
98		-	by federal law.
99		-	(d) A health carrier shall not be required to approve
100		-	any application for credentialing, except as provided by
101		-	W.S. 26-22-503.
102		-	Section 2. The department of insurance shall
103		-	promulgate rules providing for a uniform credentialing
104		-	application that shall be used by applicants and health ORIGINAL HOUSE
105		-	BILL NO. HB0082
106		-	ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
107		-	SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
108		-	2025 GENERAL SESSION
109		-	4
110		-	carriers. Dental and vision insurance are exempt from using
111		-	the uniform application.
112		-	Section 3. Nothing in this act shall require a health
113		-	carrier to violate or fail to meet a standard or
114		-	requirement of a nationally recognized accrediting entity.
115		-	Section 4. This act shall apply to applications for
116		-	credentialing submitted to health carriers on or after July
117		-	1, 2025. ORIGINAL HOUSE
118		-	BILL NO. HB0082
119		-	ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
120		-	SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
121		-	2025 GENERAL SESSION
122		-	5Section 5.
123		-	(a) Except as otherwise provided by subsection (b) of
124		-	this section, this act is effective July 1, 2025.
125		-	(b) Sections 2 and 5 of this act are effective
126		-	immediately upon completion of all acts necessary for a
127		-	bill to become law as provided by Article 4, Section 8 of
128		-	the Wyoming Constitution.
129		-	(END)
130		-	Speaker of the HousePresident of the SenateGovernorTIME APPROVED: _________DATE APPROVED: _________
131		-	I hereby certify that this act originated in the House.
132		-	Chief Clerk
	28	+	4 (a) As used in this chapter:
	29	+	5
	30	+	6 (i) "Applicant" means a health care provider who
	31	+	7 submits an application to a health carrier to become
	32	+	8 credentialed as a participating health care provider in one
	33	+	9 (1) or more of the health carrier's provider networks;
	34	+	10
	35	+	11 (ii) "Application" means an applicant's most
	36	+	12 recent application to become credentialed by a health
	37	+	13 carrier as a participating health care provider in one (1)
	38	+	14 or more of the health carrier's provider networks;
	39	+	15
	40	+	16 (iii) "Completed credentialing application"
	41	+	17 means a credentialing application that is free of defects
	42	+	18 and contains all of the information that, when later
	43	+	19 supplemented by verification and documentation gathered by
	44	+	20 the health carrier during the primary source verification
	45	+	21 process, is necessary for the health carrier to make a
	46	+	22 credentialing decision;
	47	+	23 2025STATE OF WYOMING25LSO-00323HB00821 (iv) "Credentialing" means the process by which
	48	+	2 a health carrier or its designee collects information
	49	+	3 concerning an applicant, assesses whether the applicant
	50	+	4 satisfies the requirements to become a participating health
	51	+	5 care provider in one (1) or more of the health carrier's
	52	+	6 provider networks, verifies all information submitted by
	53	+	7 the applicant and approves or denies the applicant's
	54	+	8 application;
	55	+	9
	56	+	10 (v) "Health carrier" means as defined by W.S.
	57	+	11 26-13-303(a)(iii) and shall not mean pharmacy benefit
	58	+	12 managers as defined by W.S. 26-52-102(a)(vii).
	59	+	13
	60	+	14
	61	+	15
	62	+	16
	63	+	17 (a) Within seven (7) calendar days after a health
	64	+	18 carrier receives an application for credentialing, the
	65	+	19 health carrier shall provide the applicant notice of
	66	+	20 receipt of the application in written or electronic form
	67	+	21 and contact information for the person reviewing the
	68	+	22 application. After receiving an application, a health
	69	+	23 carrier shall determine whether the application is 2025STATE OF WYOMING25LSO-00324HB0082
	70	+	1 complete. If the health carrier determines that the
	71	+	2 application is incomplete, the health carrier shall notify
	72	+	3 the applicant in writing or by electronic means that the
	73	+	4 application is incomplete within thirty (30) calendar days
	74	+	5 after the date the health carrier received the application.
	75	+	6 The notice shall describe the items that are required to
	76	+	7 complete the application. The health care provider shall
	77	+	8 submit a completed credentialing application within thirty
	78	+	9 (30) calendar days of receiving the notice. Failure of the
	79	+	10 health care provider to submit a completed credentialing
	80	+	11 application within thirty (30) days of receiving the notice
	81	+	12 shall restart the timelines in this subsection.
	82	+	13
	83	+	14 (b) A health carrier shall conclude the process of
	84	+	15 credentialing an applicant within sixty (60) calendar days
	85	+	16 after the health carrier receives the applicant's
	86	+	17 application. The sixty (60) calendar day period shall pause
	87	+	18 if a health care provider receives notification that their
	88	+	19 application is incomplete and shall resume after the health
	89	+	20 carrier verifies that the health care provider has
	90	+	21 resubmitted a completed credentialing application. A health
	91	+	22 carrier shall provide each applicant written or electronic 2025STATE OF WYOMING25LSO-00325HB0082
	92	+	1 notice of the outcome of the applicant's credentialing at
	93	+	2 the conclusion of the credentialing process.
	94	+	3
	95	+	4 (c) If an applicant becomes credentialed as a
	96	+	5 participating health care provider in a health carrier's
	97	+	6 network and a fully executed contract between the health
	98	+	7 care provider and the health carrier is in effect prior to
	99	+	8 covered services being provided, the health carrier shall
	100	+	9 reimburse the applicant for all covered reimbursable health
	101	+	10 care services provided by the applicant beginning with the
	102	+	11 date the health carrier received a completed credentialing
	103	+	12 application from the applicant, unless otherwise preempted
	104	+	13 by federal law.
	105	+	14
	106	+	15 (d) A health carrier shall not be required to approve
	107	+	16 any application for credentialing, except as provided by
	108	+	17 W.S. 26-22-503.
	109	+	18
	110	+	19. The department of insurance shall
	111	+	20 promulgate rules providing for a uniform credentialing
	112	+	21 application that shall be used by applicants and health
	113	+	22 carriers. Dental and vision insurance are exempt from using
	114	+	23 the uniform application. 2025STATE OF WYOMING25LSO-00326HB00821
	115	+	2. Nothing in this act shall require a health
	116	+	3 carrier to violate or fail to meet a standard or
	117	+	4 requirement of a nationally recognized accrediting entity.
	118	+	5
	119	+	6. This act shall apply to applications for
	120	+	7 credentialing submitted to health carriers on or after July
	121	+	8 1, 2025.
	122	+	9
	123	+	10.
	124	+	11
	125	+	12 (a) Except as otherwise provided by subsection (b) of
	126	+	13 this section, this act is effective July 1, 2025.
	127	+	14
	128	+	15 (b) Sections 2 and 5 of this act are effective
	129	+	16 immediately upon completion of all acts necessary for a
	130	+	17 bill to become law as provided by Article 4, Section 8 of
	131	+	18 the Wyoming Constitution.
	132	+	19
	133	+	20 (END)