What is prior authorization?
Prior authorization (PA) means the health plan must approve certain care before it will cover it. Providers often submit requests for you, but you still have rights if PA is denied or delayed.
Overview: Prior authorizations. Wyoming-only details below.
Confirm plan type: Wyoming: Start Here.
Wyoming PA rules
Wyoming passed comprehensive prior authorization reform in 2024 (Ensuring Transparency in Prior Authorization Act, W.S. 26-55). Before that law, Wyoming was one of the few states with no PA-specific insurance rules.
Decision timelines (§ 26-55-102)
- Standard PA: insurer must notify enrollee and provider within 5 calendar days
- Urgent PA: within 72 hours (includes mental and behavioral health when clinically urgent)
Who reviews PA (§ 26-55-104)
Adverse determinations must be made by a licensed physician or other appropriate provider with relevant specialty knowledge, without conflicts tied to the initial denial.
Peer-to-peer (§ 26-55-105)
After an adverse PA determination, the insurer must offer the treating provider a discussion of medical necessity within 5 business daysof the provider's request.
Transparency (§ 26-55-103)
Current PA requirements must be easily accessibleon the insurer's website. New or amended requirements require 60 days' written notice before implementation.
Continuity when you switch plans (§ 26-55-107)
If you had an approved PA from a prior insurer and the same benefit is covered under your new plan, the new insurer must honor that PA for at least 90 days after coverage starts.
How long PA stays valid (§ 26-55-110)
- Outpatient and most prescription drug PA: at least 1 year
- Inpatient PA: at least 1 day, based on clinical condition
- Chronic-condition services (not including certain controlled substances): valid 1 year
Step therapy (§ 26-55-111)
Enrollees generally cannot be required to repeat step therapy if they already completed it (or a same-class drug) on a prior plan; the prescriber may need to submit clinical justification.
Gold carding (§ 26-55-112)
Effective January 1, 2026, providers with at least 5 PA requests for a specific service in 12 months and at least a 90% approval rate (rounded down) may be exempt from PA for that service with that insurer for up to 12 months. Pharmacy and prescription drugs are excluded. Insurers must notify qualifying providers; providers may appeal a denied exemption.
Federal CMS timing (many plans, 2026)
Many Marketplace, Medicare Advantage, and Medicaid managed care plans must also follow federal PA rules (72-hour urgent / 7-day standard, denial reasons, and public reporting).
Where to look up PA rules
Check your plan materials and the carrier's member or provider portal first.
Carrier links: Wyoming prior auth & internal appeals links.
Medicaid
Wyoming Medicaid prior authorization follows state Medicaid rules and the WYhealth program—not the commercial W.S. 26-55 gold-carding provisions. Service denials may require provider appeal to Medicaid or a member fair hearing.
If PA is denied
Appeal through your plan's internal review process, then external review if the denial is based on medical necessity.
Next: Wyoming internal appeals.
Urgent care
Urgent PA decisions must be made within 72 hours under W.S. 26-55. If PA is denied on an urgent basis, request expedited internal review and, if needed, expedited external review under Chapter 63 (72-hour IRO decision).