Sec. 13. (a) A fully credentialed provider shall be reimbursed for eligible services provided at any in-network hospital if the following conditions are met:
(1) The provider submits the documentation required by the insurer to be loaded under the provider group or hospital.
(2) The provider, provider group, or hospital is a network provider with the insurer.
(3) The services are provided in accordance with all terms and conditions of the provider's, group provider's, or hospital's agreement or contract with the insurer.
(4) Prior authorization is obtained in accordance with IC 27-1-37.5 when required by the insurer for an eligible service.
(b) The insurer shall reimburse the provider or hospital for services described in subsection (a) at the rates determined by the contract between the provider and the insurer.
(c) An insurer is not required to credential a provider. However, if:
(1) a provider is employed by a hospital that is part of the hospital's network that is covered by the insurer; and
(2) the provider meets the insurer's credentialing requirements;
the insurer shall reimburse the provider for any reimbursable services from the date that the provider was employed by the hospital.
As added by P.L.50-2020, SEC.8.
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