Sec. 1.2. (a) The division shall, upon receipt of a claim pertaining to a person:
(1) who was provided care by an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the medical conditions identified in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or services identified in the claim were necessitated by the person's medical condition or, if applicable, if the items or services were a direct consequence of the person's medical condition.
(b) In conducting the review of a claim referenced in subsection (a), the division shall calculate the amount of the claim. For purposes of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and IC 12-16-7.5, the amount of a claim shall be calculated in a manner described in IC 12-16-7.5-2.5(c).
As added by P.L.145-2005, SEC.14. Amended by P.L.212-2007, SEC.18; P.L.218-2007, SEC.29.
Structure Indiana Code
Article 16. Payment for Health Services Other Than Medicaid
Chapter 5.5. Hospital Care for the Indigent; Eligibility Determinations; Investigations
12-16-5.5-1.2. Prompt Review of Claim; Calculation of Claim
12-16-5.5-2. Disclosure of Information by Provider; Immunity
12-16-5.5-3. Denial of Eligibility Claim; Notice; Eligibility Information
12-16-5.5-3.2. Denial of Item or Service Claim; Notice; Item or Service Information
12-16-5.5-4. Notification to Person and Provider; Requirements