The Wyoming Affidavit of Direct Payment is a legal document used to establish direct payment from an insurance company to a medical provider in Wyoming. This document must be completed and signed by both the medical provider and the insurance company in order to initiate direct payment for medical services rendered. There are two types of Wyoming Affidavit of Direct Payment. The first is the Standard Affidavit, which is used when the insurance company is paying the medical provider directly for services rendered. The second is the Assignment Affidavit, which is used when the insurance company is assigning payments to be made by a third party. Both documents are required to be filed with the Wyoming Insurance Department.
Wyoming Affidavit of Direct Payment
State:
Wyoming
Control #:
WY-UC-CS-02
Format:
PDF
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Affidavit of Direct Payment
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