006-3 Wyo. Code R. §§ 3-6 - Initiation of Proceedings
Proceedings other than medical necessity determinations shall be initiated as follows:
(a) The
complainant shall file a statement of dispute the Department. The statement of
dispute shall be filed within six (6) months of the final notification of
denial sent to the employee upon completion of the internal appeals process
required by the Carrier. The final notification must be in a written form and
may include, but is not limited to, a letter, notification, or explanation of
benefits sent to the employee. The statement of dispute shall contain the
following:
(i) The complainant's name,
address, telephone number, social security number, and place of
employment;
(ii) A brief
description of the dispute;
(iii)
If the dispute involves the denial of coverage or of a claim, the statement
shall include the reasons for denial, as understood by the
complainant;
(iv) Copies of any
relevant documents, including but not limited to bills, statements, and the
carrier's explanation of benefits;
(v) Information regarding any contacts the
complainant has had with the opposing party regarding the disputed matter,
including attempts to settle the dispute; and,
(vi) A statement verifying that a copy of the
statement of dispute has been sent to the carrier or other opposing party, and
stating the date upon which the copy was sent.
(b) The Department will then forward the
statement of dispute to the Office of Administrative Hearings to commence a
contested case hearing.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.