Sec. 5.2. (a) A person may not act as a claim review consultant concerning health care services delivered to an enrollee in Indiana unless the person holds a certificate of registration issued by the department under this chapter.
(b) To obtain a certificate of registration under this chapter, a person must submit to the department an application containing the following:
(1) The name, address, telephone number, and normal business hours of the person.
(2) The name and telephone number of a person that the department may contact concerning the information in the application.
(3) Documentation necessary for the department to determine that the person is capable of satisfying the minimum requirements set forth in this chapter.
(c) An application submitted under this section must be:
(1) signed and verified by the applicant; and
(2) accompanied by an application fee in the amount established under subsection (d).
The commissioner shall deposit an application fee collected under this subsection into the department of insurance fund established by IC 27-1-3-28.
(d) The department shall set the amount of the application fee required by subsection (c) and section 6(a) of this chapter in the rules adopted under section 14 of this chapter. The amount may not be more than is reasonably necessary to generate revenue sufficient to offset the costs incurred by the department in carrying out the department's responsibilities under this chapter.
(e) The department shall issue a certificate of registration to a claim review consultant that satisfies the requirements of this section.
As added by P.L.260-1995, SEC.5. Amended by P.L.173-2007, SEC.37; P.L.234-2007, SEC.194.
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