Sec. 7. (a) As used in this chapter, "utilization review agent" means any entity performing utilization review, except the following:
(1) An agency of the state or federal government.
(2) An agent acting on behalf of the federal or state government.
(3) Entities conducting general in-house utilization review for hospitals, home health agencies, health maintenance organizations, preferred provider organizations or other managed care entities, clinics, private offices, or any other health facility, so long as the review does not result in the approval or denial of an enrollee's coverage for hospital or medical services.
(b) However, an agent described in subsection (a)(2) who performs utilization review for a person other than the federal or state government is a utilization review agent who is subject to the requirements of this chapter.
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