Sec. 8. (a) A contract entered into by a hospital with the office's managed care organization for the provision of services under the office's managed care program must include a dispute resolution procedure for all disputed claims. Unless agreed to in writing by the hospital and the office's managed care organization, the dispute resolution procedure must include the following requirements:
(1) That submission of disputed claims must be made to an independent arbitrator selected under subsection (b).
(2) Each claim must set forth with specificity the issues to be arbitrated, the amount involved, and the relief sought.
(3) That the hospital and the office's managed care organization shall attempt in good faith to resolve all disputed claims.
(4) The hospital shall submit to the arbitrator any claims that remain in dispute sixty (60) calendar days after the hospital receives written notice as provided under section 7 of this chapter.
(5) That resolution of disputes by the arbitrator must occur not later than ninety (90) calendar days after submission of disputed claims to the arbitrator, unless the parties mutually agree otherwise.
(6) That determinations of the arbitrator are final and binding and not subject to any appeal or review procedure.
(7) That the arbitrator does not have the authority to award any punitive or exemplary damages or to vary or ignore the terms of any contract between the parties and shall be bound by controlling law.
(8) That judgment upon the award rendered by the arbitrator may be entered and enforced in and is subject to the jurisdiction of a court with jurisdiction in Indiana.
(9) That the cost of the arbitrator must be shared equally by the parties, and each party must bear its own attorney and witness fees.
(b) The parties to a contract described in subsection (a) shall mutually agree on an independent arbitrator, or, if the parties are unable to reach agreement on an independent arbitrator, the following procedure must be followed:
(1) Each party shall select an independent representative, and the independent representatives shall select a panel of three (3) independent arbitrators who have experience in institutional and professional health care delivery practices and procedures and have had no prior dealing with either party other than as an arbitrator.
(2) The parties will each strike one (1) arbitrator from the panel selected under subdivision (1), and the remaining arbitrator serves as the arbitrator of the disputed claims under subsection (a).
(3) The procedures for selecting an arbitrator under this section must be completed not later than twenty (20) calendar days after the hospital provides written notice of at least one (1) disputed claim.
As added by P.L.142-2000, SEC.2. Amended by P.L.152-2017, SEC.11.
Structure Indiana Code
Chapter 11.5. Lake County Disproportionate Share Hospitals
12-15-11.5-0.5. Nonapplicability to Certain Managed Care Organizations
12-15-11.5-2. Hospital as Contracted Provider to Eligible Individuals
12-15-11.5-6. Claim for Reimbursement Treated as Disputed Claim
12-15-11.5-7. Conclusion of Appeal