Sec. 6. (a) As used in this chapter, "utilization review" means a system for prospective, concurrent, or retrospective review of the medical necessity and appropriateness of health care services provided or proposed to be provided to a covered individual.
(b) The term does not include the following:
(1) Elective requests for clarification of coverage, eligibility, or benefits verification.
(2) Medical claims review (as defined in IC 27-8-16-4).
As added by P.L.128-1992, SEC.1.
Structure Indiana Code
Article 8. Life, Accident, and Health
Chapter 17. Health Care Utilization Review
27-8-17-1. "Covered Individual" Defined
27-8-17-2. "Department" Defined
27-8-17-4. "Health Maintenance Organization" Defined
27-8-17-5. "Provider of Record" Defined
27-8-17-6. "Utilization Review" Defined
27-8-17-7. "Utilization Review Agent" Defined
27-8-17-8. "Utilization Review Determination" Defined
27-8-17-9. Certificate of Registration; Issuance to Agent
27-8-17-10. Certificate of Registration; Renewal; Transfer; Notice of Change in Information
27-8-17-11. Minimum Utilization Review Agent Requirements
27-8-17-13. Physician's Statement; Documentation of Review Agent Capability
27-8-17-16. Fraudulent or Misleading Information; Penalties
27-8-17-18. Confidential Information