Wyoming's Workers' Compensation Division uses this one-page request to review higher-cost durable medical equipment before it is supplied to an injured worker. It applies only above the Division's dollar threshold; lower-cost DME needs no preauthorization and is billed straight to CorVel. A DME coordinator nurse completes the bottom block with the decision, a preauthorization number and the dates the approval is valid.
The requesting provider or DME supplier fills in the claimant, claim number, requestor's federal tax ID and contacts, and lists each item with HCPCS code, description, quantity, quote and time frame. The treating provider supplies the order or letter of medical necessity, and only the Division's DME coordinator nurse completes the authorization block.
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Durable Medical Equipment Preauthorization Request
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No. The Division reviews DME only above its preauthorization price threshold, and only on a voluntary basis. Since September 1, 2021, lower-cost DME needs no preauthorization and is billed directly to CorVel. All DME bills are still reviewed under Chapter 10, Section 8 of the Division's rules.
The Division requires the treating health care provider's order or letter of medical necessity, the diagnosis codes, and clinical medical documents supporting the request. On the form itself, list each item with its HCPCS code and description, the quantity, the quote and, where relevant, the time frame of use.
The Division's RN DME coordinators review the request. The bottom section is reserved for the coordinator nurse, who marks the authorization, signs, adds comments and assigns a preauthorization number along with the dates the approval is valid.