Sec. 1. (a) The definitions in this section apply throughout this chapter.
(b) "Credentialing" means a process through which an insurer makes a determination:
(1) based on criteria established by the insurer; and
(2) concerning whether a provider is eligible to:
(A) provide health care services to an insured; and
(B) receive reimbursement for the health care services;
under an agreement entered into between the provider and the insurer under section 3 of this chapter.
(c) "Health care services":
(1) means health care related services or products rendered or sold by a provider within the scope of the provider's license or legal authorization; and
(2) includes hospital, medical, surgical, dental, vision, and pharmaceutical services or products.
(d) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by an insurer.
(e) "Insurer" means an insurance company authorized in this state to issue policies that provide reimbursement for expenses of health care services.
(f) "Person" means an individual, an agency, a political subdivision, a partnership, a corporation, an association, or any other entity.
(g) "Preferred provider plan" means an undertaking to enter into agreements with providers relating to terms and conditions of reimbursements for the health care services of insureds, members, or enrollees relating to the amounts to be charged to insureds, members, or enrollees for health care services.
(h) "Provider" means an individual or entity duly licensed or legally authorized to provide health care services.
As added by P.L.140-1984, SEC.1. Amended by P.L.31-1988, SEC.22; P.L.26-2005, SEC.1.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 11. Accident and Sickness Insurance─reimbursement Agreements
27-8-11-0.1. Application of Certain Amendments to Chapter
27-8-11-2. Conflicting Provisions
27-8-11-3. Reimbursement Agreements; Immunity
27-8-11-4. Accessibility and Availability Terms; Reasonable Standards
27-8-11-5. Preferred Provider Plans; Filing Sworn Statement
27-8-11-6. Preferred Provider Plans; Hospital Accreditation
27-8-11-7. Provider Credentialing
27-8-11-8. Provider Directories
27-8-11-9. Preferred Provider Agreement Prohibitions
27-8-11-10. Coverage for Dialysis Treatment
27-8-11-11. Insurer Payment to Insured for Service Rendered by Noncontracted Provider; Requirements
27-8-11-13. Fully Credentialed Provider Reimbursement; Requirements