Sec. 11. (a) The compensation of a claim review agent for the performance of medical claims review may not be based on the amount by which claims are reduced for payment.
(b) The compensation of a claim review consultant for making a recommendation or providing consultation concerning the appropriateness of or amount charged for a health care service delivered to an enrollee in Indiana may not be based on the amount by which a claim relating to the service is reduced for payment.
As added by P.L.128-1992, SEC.2. Amended by P.L.260-1995, SEC.8.
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