Preauthorization of hospitalizations, surgeries and medical care are allowed by Wyoming Statute 24-14-601 (o) (i), (ii), (iii), (iv) as of July 1, 2005. Rule and Regulation Chapter 10 Miscellaneous Medical Protocols Section 22.
- Dispute Resolution
- Emergency Treatment
- Health Care Provider requirements to supply information
- How the Preauthorization Process Works
- Medical Disability Timeframes
- Preauthorization Contacts
- Preauthorization Numbers
- Preauthorization Program
- Services Requiring Peer Review
- Timeframes
- Timeframes, Procedures and Notice Content
- What the Division Preauthorization nurse will do with the request
Request for Surgical/Procedural Preauthorization
- Provider Request for Preauthorization Review
- Provider Request for Preauthorization Review (Printable Version)
Preauthorization Check Sheets
- Cervical Artificial Disc Checklist
- Lumbar Artifical Disc Checklist
- SI Fusion
- Oswestry Back Questionnaire
- Oswestry Neck Questionnaire
- SCS Trial Policy Checklist FBS (PDF-SCS Trial FBS 9.1.22)
- SCS Trial Policy Checklist CRPS (PDF-SCS Trial CRPS 9.1.22)
- SCS Perm Policy Checklist (PDF-SCS PERM 9.1.22)
- SCS Revision Policy Checklist (PDF-SCS Revision 9.1.22)
- Physical Demand Assessment for SCS Trials (PDF-Physical Demand Assessment 9.1.22)
- Spinal Fusion Checklist
DME (Durable Medical Equipment) Preauthorization
Send requests to the contact below. Please include a LOMN or prescription, a quote with codes, pricing and the medical records to support along with vendor contact information.
- DME Authorization Form
- Home and Vehicle Mod Request Form
- Preauthorization of Durable Medical Equipment Billing less than $2500
Heidi Gerken, BSN, RN, DME Coordinator
(307) 687-5304
(307) 687-5312 Fax
heidi.gerken@wyo.gov