The bill amends the Wyoming insurance code to establish specific requirements for dental insurance billing and coding practices. It prohibits entities contracting with dentists from imposing certain restrictions, such as requiring dentists to provide services at a fee set by the contract unless those services are covered, using downcoding to prevent providers from collecting fees for actual services performed, and utilizing bundling practices that mislabel procedure codes as nonbillable. Additionally, the bill mandates that any adjustments to procedure codes must be consistent with the entity's policies and that explanations of benefits must clearly state the reasons for downcoding or any claims of excessive charges.

Furthermore, the bill introduces definitions for terms such as "covered services," "bundling," and "downcoding," and allows dentists, with informed patient consent, to collect fees for services that have been downcoded or denied based on their published fee schedules. The existing subsection (c) of W.S. 26-22-505 is repealed, and the new provisions will apply to contracts, policies, or certificates entered into or issued on or after July 1, 2025, while not affecting existing agreements made prior to that date. The act is set to take effect on July 1, 2025.

Statutes affected:
Introduced: 26-22-505