044-63 Wyo. Code R. §§ 63-11 - Approval of Independent Review Organizations

(a) The commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under W.S. § 26-40-201.

(b) In order to be eligible for approval by the commissioner under this section to conduct external reviews an independent review organization:

(i) Shall be accredited by Utilization Review Accreditation Commission (URAC) or another nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under Section 12 of this Rule; and

(ii) Shall submit an application for approval in accordance with subsection (c).

(c) The commissioner shall develop an application form for initially approving and for re-approving independent review organizations to conduct external reviews.

(d) Any independent review organization wishing to be approved to conduct external reviews under this Rule shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the independent review organization satisfies the minimum qualifications established under Section 12 of this Rule.

(e) Subject to subparagraph (i) of this paragraph, an independent review organization is eligible for approval under this section only if it is accredited by URAC or another nationally recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations under Section 12 of this Rule.

(i) The commissioner may approve independent review organizations that are not accredited by URAC or another nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.

(ii) The independent review organization shall submit an application fee in the sum of one hundred dollars ($100.00) to the commissioner with an application for approval and re-approval.

(iii) An approval is effective for two (2) years, unless the commissioner determines before its expiration that the independent review organization is not satisfying the minimum qualifications established under Section 12 of this Rule.

(iv) Whenever the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under Section 12 of this Rule, the commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under this Rule that is maintained by the commissioner pursuant to subsection (f).

(f) The commissioner shall maintain and update a list of approved independent review organizations within fifteen (15) days of approval or determination of eligibility.

Notes

044-63 Wyo. Code R. §§ 63-11

Amended, Eff. 10/13/2015.