Sec. 0.5. (a) This chapter applies to the following:
(1) A person who conducts medical claims review concerning health care services delivered to an enrollee in Indiana.
(2) A person who acts as a claim review consultant concerning the:
(A) appropriateness of; or
(B) amount charged for;
a health care service delivered to an enrollee in Indiana.
(b) This chapter does not apply to:
(1) the payment of benefits or compensation;
(2) the furnishing of medical, surgical, hospital, or nursing services; or
(3) the payment by an insurer or employer to the provider of health care services for services provided;
under IC 22.
As added by P.L.260-1995, SEC.1.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 16. Medical Claims Review
27-8-16-0.5. Applicability of Chapter
27-8-16-1. "Claim Review Agent" Defined
27-8-16-1.5. "Claim Review Consultant" Defined
27-8-16-2. "Department" Defined
27-8-16-4. "Medical Claims Review" Defined
27-8-16-5. Certificate of Registration; Issuance to Agent
27-8-16-5.2. Certificate of Registration; Application; Requirements; Application Fee
27-8-16-6. Certificate of Registration; Renewal; Transfer; Notice of Change in Information
27-8-16-7. Minimum Claim Review Agent Requirements
27-8-16-9. Provider's Statement; Documentation of Review Agent Capability
27-8-16-9.5. Claim Determinations Based on Data Base Information
27-8-16-10. Fraudulent or Misleading Information; Penalties
27-8-16-11. Prohibited Bases for Compensation of Claim Review Agents and Consultants