Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0064 - Kid Care CHIP
Chapter 1 - GENERAL PROVISIONS
Section 1-9 - Reconsideration and Administrative Hearings

(a) A participating insurance company may request that the Department reconsider a decision to recover overpayments. Such request shall be mailed to the Department by certified mail, return receipt requested, within twenty (20) days of the date of the notice of overpayment. The reconsideration provisions of Chapter 16 of the Medicaid rules, shall govern all aspects of the reconsideration and any administrative hearings shall be governed by Chapter 4 of the Medicaid rules.

(b) Eligibility determinations and redeterminations. An applicant or insured who is denied eligibility or terminated from eligibility may request an administrative hearing pursuant to Chapter 4 of the Medicaid rules. Chapter 4 of the Medicaid rules shall govern administrative hearings involving Kid Care CHIP eligibility issues in all respects, except that a request for hearing on issues involving eligibility for Kid Care CHIP shall be mailed or hand-delivered to the Department within thirty (30) days from the date of the notice of adverse action,

(c) Denial of services or other coverage issues. An insured who is denied services or has any other complaint regarding covered services shall be entitled to review of that decision pursuant to the procedures provided by the participating insurance company. Such action is not adverse action, and the insured shall not be entitled to reconsideration or an administrative hearing regarding such decision pursuant to this Section or Chapter 4 of the Medicaid rules.