Statutes, codes, and regulations
Wyoming Administrative Code
Agency 053 - Workforce Services, Department ofSubagency 0021 - Workers' Compensation Division
Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS
Section 10-23 - Preauthorization

053-10 Wyo. Code R. § 10-23

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Current through April 27, 2019
Section 10-23 - Preauthorization

The Division pursuant to its rules and regulations may issue a determination of preauthorization for an injured worker's nonemergency hospitalization, surgery or other specific medical care. W.S. § 27-14-601(o) as amended.

(a) Treatment rendered by a health care provider to a Wyoming workers' compensation claimant for injuries, will be professionally reviewed and preauthorized on issues of whether proposed treatment is reasonable, medically necessary and in compliance with the Division's rules, regulations and treatment guidelines. Such treatment guidelines shall be predicated on relevant medical literature consistent with current evidence-based medicine, or insurance industry standards or practices, or the guidance of the Medical Commission, and shall be available upon request. Policy establishing treatment guidelines shall be available in written format and also maintained on the Division's Internet web site located at: www.wyomingworkforce.org/providers/preauth/

(b) The Division will institute procedures of preauthorization and utilization review. Policy outlining the description, medical definitions, and a required list of treatments to be preauthorized shall be developed, implemented and maintained.

(c) The Division will inform Health Care Providers when treatment guidelines are expanded or modified, or there are changes in division policy or procedures.

(d) The Preauthorization Process

  • (i) Health Care Provider notification to the Division.
    • (A) The Health Care Provider must complete the request for preauthorization review form in writing, in advance of the injured worker receiving treatment for hospitalizations, surgeries or health care requiring preauthorization and submit it to the Division by fax, mail, or e-mail. The Provider Request for Preauthorization form can be obtained from the Division or through the Internet at: www.wyomingworkforce.org/providers/preauth/
    • (B) Concurrent with submission of the Provider Request for Preauthorization, the Health Care Provider must supply relevant clinical information. This will include chart notes that document the injured worker's history, physical examination findings, diagnostic test results, treatment plan, and prognosis.
  • (ii) The Division will make a determination to authorize or deny treatment as requested per the preauthorization review form, pursuant to the procedures outlined in W.S. 27-14-601(k).

(e) The Administrator or the Administrator's designee will make medical coverage decisions to ensure quality of care and prompt treatment of injured workers. Medical coverage policies and procedures will include, but are not limited to, decisions on health care services, hospitalizations, surgical procedures, medical care, pharmaceuticals, rehabilitative modalities, devices, diagnostic tests, ambulatory services, and supplies rendered for the purpose of diagnosis, treatment or prognosis.

053-10 Wyo. Code R. § 10-23

Amended, Eff. 8/24/2017.