Section 26-55-104 - Persons qualified to make adverse determinations(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.Added by Laws 2024, ch. 19,§ 1, eff. 7/1/2024.