What is Interoperability?
The CMS Interoperability and Prior Authorization final rule (CMS-0057-F) is a new set of federal regulations designed to improve the electronic exchange of health information and streamline the prior authorization process. For Wyoming Medicaid members, this means your health data will be easier to access, and decisions about your medical care will be made more quickly and transparently.
New Rules for Better Care
The Centers for Medicare & Medicaid Services (CMS) made a new rule (called CMS-0057-F) to help patients and doctors. Here is what it does:
- Faster Decisions: Starting in 2026, health plans must decide on most “urgent” requests within 72 hours and “standard” requests within 7 calendar days.
- Clear Reasons: If a health plan says “no” to a request, they must give a specific reason why.
- Public Reports: Every year, health plans will post reports on their websites. These reports show how many requests they approved or denied and how fast they made those choices. Check out our linked reports below!
Reports and Data
Wyoming works with different partners (vendors) to make prior authorization determinations for our members. You can find their reports below to see how we are meeting these new interoperability goals.
- The Care Management Entity (CME) for the High Fidelity Wraparound (HFWA) program, processes Prior Authorizations (PAs) for behavioral and mental health services for members specifically enrolled in their program. View the CME Report.
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Utilization Management (UM) includes PA reviews of many different medical procedures and services for Wyoming Medicaid members. View the UM Report.
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The Home and Community Based Services (HCBS) Program processes PAs for participant support services that are outlined in each waiver member’s plan of care. These services are requested through a PA process. View the HCBS Report.
Questions?
If you have questions about how your health data is shared or about prior authorizations, we are here to help.
- For questions about prior authorizations or your Medicaid benefits, please contact the Customer Service Center: 855-294-2127
- For questions about how your health data is shared, please visit the Wyoming Department of Health Office of Privacy, Security, and Contracts.
- For more information about the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), please visit the Centers for Medicare and Medicaid webpage.
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This page was last updated on March 25, 2026.