Sec. 9.5. (a) As used in this section, "data base" means a data base that provides information concerning health care services or amounts charged for health care services.
(b) If a claim review agent bases a medical claims review determination concerning a health care service provided by a hospital licensed under IC 12-25 or IC 16-21 in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.
(c) If a claim review consultant makes a recommendation or provides consultation concerning the appropriateness of or the amount charged for services provided by a hospital licensed under IC 12-25 or IC 16-21 based in whole or in part on information obtained from a data base, the information must relate exclusively to services provided by a hospital licensed under IC 12-25 or IC 16-21.
(d) This section does not apply to:
(1) medical claims review determinations made under subsection (b); or
(2) consultations or recommendations made under subsection (c);
regarding medical services provided under IC 22.
As added by P.L.260-1995, SEC.7.
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