Preauthorization of hospitalizations, surgeries and medical care are allowed by Wyoming Statute 24-14-601 (o), and Wyoming Rules, Regulations and Fee Schedules; Chapter 10; Section 23.
“The Division pursuant to its rules and regulations may issue a determination of preauthorization for an injured worker’s non-emergent hospitalization, surgery, or other specified medical care.”
The Division will currently review requests for surgical procedures and Durable Medical Equipment >$2,500 for preauthorization only on a voluntary basis.
- Proceso de autorización previa
- Provider Requirements for Preauthorization Request Forms
- How the Preauthorization Process Works
- Preauthorization Contacts
- Preauthorization Program Description
- Services Requiring Peer Review
- Timeframes
REQUEST FOR SURGICAL/PROCEDURAL PREAUTHORIZATION
- Provider Request for Preauthorization Review (Printable)
- Provider Request for Preauthorization Review (Not Printable Version)
PREAUTHORIZATION CHECK SHEETS
- Cervical Artificial Disc Checklist
- Lumbar Artificial Disc Checklist
- Oswestry Back Questionnaire
- Oswestry Neck Questionnaire
- Matrix-induced Autologous Chondrocyte Implantation (MACI) Policy Checklist
- SI Fusion
- 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 Permanent 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
DURABLE MEDICAL EQUIPMENT (DME) PREAUTHORIZATION
DME requests are based on price. If greater than $2,500, please complete the DME Preauthorization Request form. If under $2,500, no DME preauthorization is required and can be directly billed to Corvel (please see “Preauthorization of Durable Medical Equipment Billing less than $2,500 Provider Bulletin).
All DME requests require the treating Healthcare Provider’s order and/or Letter of Medical Necessity, diagnosis code(s), and clinical medical documents to support the DME request, and are subject to review.
DME requests are based on Chapter 10: Miscellaneous Medical Protocols, Section 8: Durable Medical Equipment (DME).
- DME Preauthorization Request Form
- Home and Vehicle Modification Preauthorization Request Form
- Preauthorization of Durable Medical Equipment Billing less than $2,500
- DME Guidelines
- NexWave Preauthorization Checklist
If you have questions about the DME process, please contact the RN-DME Coordinator at phone: 307-687-5304, fax: 307-777-8724 or email at heidi.gerken@wyo.gov.
DME PROVIDER BULLETINS
- Active/Passive Cooling and Heating Devices DME Policy
- Bone Growth Stimulation DME Policy
- Cervical Traction as Durable Medical Equipment
- Continuous Passive Motion Device DME Policy
- CPAP/BiPAP DME Policy
- Exoskeleton
- Home Oxygen Therapy
- Infrared Heating
- Lumbar Traction
- PEMF
- TENS DME Policy
- Interferential Current Stimulator
- Neuromuscular Stimulator Device
- NexWave Device
- Pneumatic Compression
- Intermittent Limb Compression Device