Sec. 11.2. (a) Not more than ninety (90) days after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in this subsection:
(1) the association shall begin using the version specified in IC 27-1-1.5 of the:
(A) Current Procedural Terminology (CPT);
(B) International Classification of Diseases (ICD);
(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
(D) Current Dental Terminology (CDT);
(E) Healthcare Common Procedure Coding System (HCPCS); and
(F) third party administrator (TPA);
codes under which the association pays claims for services provided under an association policy; and
(2) a health care provider shall begin using the version specified in IC 27-1-1.5 of the:
(A) Current Procedural Terminology (CPT);
(B) International Classification of Diseases (ICD);
(C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
(D) Current Dental Terminology (CDT);
(E) Healthcare Common Procedure Coding System (HCPCS); and
(F) third party administrator (TPA);
codes under which the health care provider submits claims for payment for services provided under an association policy.
(b) If a health care provider provides services that are covered under an association policy:
(1) after the date of the version specified in IC 27-1-1.5 of a diagnostic or procedure code described in subsection (a); and
(2) before the association begins using the version of the diagnostic or procedure code;
the association shall reimburse the health care provider under the version of the diagnostic or procedure code that was specified in IC 27-1-1.5 on the date that the services were provided.
As added by P.L.161-2001, SEC.3. Amended by P.L.66-2002, SEC.15; P.L.124-2018, SEC.78.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 10. Comprehensive Health Insurance
27-8-10-0.1. Application of Certain Amendments to Chapter
27-8-10-0.5. Dissolution of the Association
27-8-10-2.3. Reporting Requirements
27-8-10-2.5. Members; General Requirements
27-8-10-2.6. Member and Health Care Provider Grievances
27-8-10-3. Association Policy Coverage; Reimbursement Methods; Eligible Expenses; Managed Care
27-8-10-3.5. Chronic Disease and Pharmaceutical Management Programs
27-8-10-3.6. Mail Order or Internet Based Pharmacy
27-8-10-4. Policies; Deductible and Coinsurance Requirements; Limitations
27-8-10-5.1. Policies; Eligible Persons; Dependent Coverage; Preexisting Conditions
27-8-10-6. Policies; Renewal Provisions; Election to Continue Coverage Upon Death of Policyholder
27-8-10-8. Civil or Criminal Liability of Association or Members
27-8-10-9. Medicare Supplement Policies
27-8-10-10. Eligibility Guidelines