ORIGINAL HOUSE
BILL NO. HB0082
ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 GENERAL SESSION
1
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. W.S. 26-56-101 and 26-56-102 are created
to read:
CHAPTER 56
HEALTH CARE PROVIDER CREDENTIALING
26-56-101. 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 ORIGINAL HOUSE
BILL NO. HB0082
ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 GENERAL SESSION
2
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.
26-13-303(a)(iii) and shall not mean pharmacy benefit
managers as defined by W.S. 26-52-102(a)(vii).
26-56-102. 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 ORIGINAL HOUSE
BILL NO. HB0082
ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 GENERAL SESSION
3
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.
Section 2. The department of insurance shall
promulgate rules providing for a uniform credentialing
application that shall be used by applicants and health ORIGINAL HOUSE
BILL NO. HB0082
ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 GENERAL SESSION
4
carriers. Dental and vision insurance are exempt from using
the uniform application.
Section 3. 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. This act shall apply to applications for
credentialing submitted to health carriers on or after July
1, 2025. ORIGINAL HOUSE
BILL NO. HB0082
ENROLLED ACT NO. 12, HOUSE OF REPRESENTATIVES
SIXTY-EIGHTH LEGISLATURE OF THE STATE OF WYOMING
2025 GENERAL SESSION
5Section 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 HousePresident of the SenateGovernorTIME APPROVED: _________DATE APPROVED: _________
I hereby certify that this act originated in the House.
Chief Clerk